Manuti et al. BMC Public Health 2010, 10:350 http://www.biomedcentral.com/1471-2458/10/350 Page 5 of 10 Table 2 Preventive health care delivered and actions to control high blood pressure among Italian adults Preventive Indicators Eligible Subjects N˚† Percent* Screening and counseling on health habits Having received screening for drinking problems all subjects all subjects § Having been asked about drug abuse history Having received smoking cessation counseling visit within 3 months all smokers identified as attempting to quit Having received smoking cessation pharmacoterapy all smokers attempting to quit who smoke more than 10 cigarettes a day all subjects # Having been asked about sexual activity history Physical examination Having received blood pressure control at least once each year all non hypertensive subjects Having received evaluation of hearing difficulties at least every 2 years subjects aged 65 and over Cancer screening services Having received cervical cancer screening through PAP smear within the past 3 years all sexually active women having an intact uterus Having received PAP smear or colposcopy in low grade lesion within 6 months of women having a PAP smear that shows a the initial PAP smear low grade lesion Having received breast cancer screening through mammography in the past 2 years women aged 50 to 70 Having been offered colorectal cancer screening tests (fecal occult blood test once subjects aged 50 to 80 each year or double contrast barium enema every 5 years or sigmoidoscopy or colonoscopy every 10 years) Having received colorectal cancer screening with sigmoidoscopy or colonoscopy subjects aged 50 to 80 within in the past 10 years Adult immunization Having been offered influenza vaccination annually subjects aged 65 and over patients with specific conditions at risk Having ever been offered pneumococcal vaccination subjects aged 65 and over patients with specific conditions at risk The advice of doctor or other health professional to help lower or control high blood pressure Having received advice to Change eating habits Having received advice to Reduce salt use Having received advice to Increase physical activity Having received advice to Reduce alcohol use Having received advice to Medication hypertensive subjects hypertensive subjects hypertensive subjects hypertensive subjects hypertensive subjects 1467 1467 68 68 1467 972 428 733 2 297 740 740 428 166 428 166 495 495 495 495 495 16 6.6 19.1 11.8 9.7 64.4 31.3 52.4 50 51.5 21.3 14.2 90.2 64.5 26.2 19.3 84 89.5 83.4 73.9 97 † Subjects in the study who were eligible for the indicator; * Percent of eligible subjects who have received the recommended preventive services; § 1079 subjects have answered to the question; # 1073 subjects have answered to the question versus 26.2% in the elderly, and 64.5% versus 19.3% in subjects with conditions at risk for severe complica- tions); older patients with worse perceived physical health status were significantly more likely to benefit from both vaccines. Discussion In this study, among a representative sample of PCP’ patients residing in Southern Italy, we had two original intentions: to examine the extent to which the health- care system succeeds in providing clinical preventive services routinely recommended to adults [24-26] and to explore the disparities in their provision with relation to the patients’ characteristics. This study clearly demonstrates that the quality of preventive care in the target population falls far short of expectations; indeed, access to preventive health services is unsatisfactory even for interventions whose effective- ness is supported by broadly accepted scientific evi- dence, such as the commonly recommended cancer screening [27-35]. Consistent with other studies con- ducted in Italy [7-9,36], we found that cancer screening for early detection of breast and cervical cancers reached about half of target population but only one-fifth for colorectal cancer; these rates are discernibly much lower than those results reported in several studies conducted, particularly in the United States, that have shown vari- able results ranging from 58% to 89% for breast cancer, from 69% to 89% for cervical cancer, and from 31% to 57% for colorectal cancer [3-5,37-42]. Our results how- ever were similar to those reported in studies conducted in vulnerable populations, such as the poor or uninsured or unenrolled in both Medicare and Medicaid programs [43-45], minority patients [46,47] and subjects who lack