EVALUATION OF PREVENTIVE AND HEALTH PROMOTION ACTIVITIES IN 166 PRIMARY-CARE PRACTICES IN SPAIN

Background. Since January 1989 the Spanish Society of Family and Commu nity Medicine has supported the Program of Prevention and Health Promo tion (PAPPS) with the following objectives: to detect possible difficu lties in the implementation of recommendations especially among asympt omatic low-risk adults and children in Spain, to disseminate those rec ommendations, and to encourage research in prevention and health promo tion in primary care. Objective. We wished to evaluate the implementat ion of PAPPS in primary care practices. Methods. A retrospective audit of medical records in practices enrolled in the programme was carried out. From 166 primary care practices widely distributed in Spain 21 6 31 patients were selected using systematic sampling. Results. Age was positively associated with correct performance in the adult population , while in the paediatric population it was negatively associated. Fem ales had a higher probability than males of having blood pressure meas urement (OR 1.34, 95% CI 1.24-1.45) and smoking counselling (OR 1.38, 95% CI 1.33-1.43) correctly performed. Practices not using the prevent ive chart had a lower probability than user practices of correctly per forming blood pressure measurement (OR 0.69, 95% CI 0.62-0.76), alcoho l counselling (OR 0.66, 95% CI 0.60-0.73) and smoking counselling (OR 0.69, 95% CI 0.63-0.76). Non-teaching practices had a higher probabili ty than teaching centres of correct performance of blood pressure meas urement (OR 1.47, 95% CI 1.35 to 1.59), alcohol counselling (OR 1.67, 95% CI 1.54 to 1.79) and smoking counselling (OR 1.39, 95% CI 1.29 to 1.51). Conclusions. There is an unequal level of performance depending on the procedure and on the target population. A preventive chart mig ht be useful in improving implementation of periodic health maintenanc e. Teaching centres with training physicians need to put more emphasis on prevention and health promotion activities.