The objective of this DNP project was to highlight the significant impact of health promotion in older adults. As of January 2011, Medicare covers an Annual Wellness Visit (AWV), which is a result of the Affordable Care Act. The AWV allows patients the benefit of receiving covered wellness and preventive care services. Through surveys this project explored what healthcare providers and patients know about the Medicare AWV and what barriers and/or challenges they have experienced with the AWV. The responses to the surveys revealed that providers have misconceptions about the Medicare AWV and some of the patients did not know that Medicare part B offers a covered annual wellness visit. There were several barriers identified by both patients and providers and these barriers will be discussed and explored in this paper.

The Annual Wellness Visit (AWV) is a benefit available to Medicare beneficiaries. This benefit has the potential to address many areas of prevention in one focused visit to the primary care clinic, yet it is currently being provided to only 19% of Medicare beneficiaries. This research attempted to examine the extent to which certified health education specialists (CHES) have provided and perceive themselves to be prepared to provide the preventive health services (PHS) within the AWV, along with seven additional preventive counseling services (PCS). A web-based survey assessed the perceived preparedness of health educators, specifically CHES (N=998), to deliver these PHS. The results of these surveys include the development of a single factor internally consistent scale to measure perceived preparedness for the PHS within the AWV. They reveal health educators were least prepared to assist with end-of-life-planning and conduct a basic hearing test. No association was found for education level and perceived preparedness; however, prior experience did account for a significant amount of the variance in perceived preparedness to provide AWV services. Lastly, when compared to historical data regarding physician’s perceived preparedness to provide PCS, health educators were more prepared to counsel on diet and exercise and less prepared to counsel on six other PCS. These results may aid in the understanding of whether CHES perceive they are prepared to provide (PHS) and demonstrate the experience CHES have with each of these PHS.

Despite the emphasis of benefits on preventive health, many older adults are not receiving the recommended age specific, evidence based screenings and vaccinations. The Medicare Annual Wellness Visit (AWV) is designed to address modifiable risk factors with aging adults and close gaps in care not captured in routine office visits. Although a free Medicare benefit to patients, and a reimbursable service to health care providers, participation in the AWV is low nationwide. The purpose of the project is to introduce an AWV program to a rural health clinic in Northwest Illinois that has a population consisting of over 25% of people 65 years and older. The rural health clinic failed to capture a single AWV in the previous year, despite having 1300 active Medicare patients in the clinic. The clinical question asked whether the implementation of an AWV program by nurse practitioners can yield improved compliance with recommended health screenings and vaccinations and diagnosed previously unrecognized clinical conditions. The Iowa model, health belief model and Donebedian's structure-process-outcome model were utilized for the introduction and implementation of the practice change. Evidence was derived from chart review of 50 patients and administration of the SF-36 survey before and following the AWV. Findings and conclusions suggest that the AWV generated improved compliance of preventive services and improved patient quality of life. Addressing preventive health strategies for aging adults is relevant to nursing practice because of the complex and chronic health challenges of this age group. These efforts can reduce the burden of suffering from chronic illness, prevent exacerbation and decline, improve quality of life, and reduce federal and individual health care expenditures to minimize the cost of advanced disease treatment.