HOW DO FAMILY PHYSICIANS PRIORITIZE DELIVERY OF MULTIPLE PREVENTIVE SERVICES

Background. In spite of the recommendations of experts, little is known about the priority that physicians assign to various preventive services provided to patients within the time pressures and competing demands of the office visit. Methods. A survey presenting the case of a 53-year-old woman was sent to a national random sample of 480 practicing family physicians. Physicians were asked which items on a list of preventive services they would provide during 5 minutes remaining at the end of an illness visit for sinusitis, and during a visit for a 30-minute physical examination. Descriptive analyses rank ordered the most commonly provided services. Additional analyses using chi-square and analysis of variance were used to characterize physicians who performed high and low levels of services recommended and not recommended by the US Preventive Services Task Force (USPSTF). Results. Among 268 responding physicians, more than 50% provided smoking cessation advice, blood pressure, height, and weight measurements, and the scheduling of a return visit during the illness visit. During a physical examination visit, many other services, including breast examination, Papanicolaou test, pelvic examination, and ordering a mammogram were also commonly chosen. Physicians performing a high level of USPSTF-recommended preventive services and a low level of not recommended services were characterized by their young age, residency training, not being in solo practice, and greater experience with USPSTF recommendations. Conclusions. Physicians offer more preventive services during patient visits for physical examinations than during visits for illness. Physician characteristics associated with the delivery of recommended levels of preventive services may be useful in identifying interventions that will direct medical resources toward the most effective preventive services.