CHANGING PHYSICIAN BEHAVIOR TO IMPROVE DISEASE PREVENTION

Physicians often fail to provide nationally recommended preventive ser vices for their patients. Addressing this, we have reviewed selected l iterature on changing physician behavior using the organizational cons truct of the ''readiness for change'' transtheoretical model. This mod el suggests that behavior evolves through stages from precontemplation , to contemplation, to preparation, to initiation, and to maintenance of change. Traditional continuing medical education may affect knowled ge and beliefs, but rarely results in behavior change. However, motiva tional strategies such as practice feedback reports and influential pe ers can foster stage change. Successful interventions aimed at physici ans preparing for change frequently use an office-system approach that targets not only physicians, but office staff and patients as well. I llustrating how the readiness to change model can guide the design and implementation of interventions, we describe strategies being used in a statewide randomized controlled trial to improve cancer prevention counseling and early detection by primary care physicians. The multist age interventions of Partners for Prevention include support from a me dical liability carrier, a motivational videotape, a task-delineated o ffice manual, chart flowsheets, patient activation forms, practice fee dback reports, a designated prevention coordinator within each practic e and regular telephone calls and office visits by project staff. (C) 1994 Academic Press, Inc.