FAMILY PHYSICIANS DISAGREEMENTS WITH THE UNITED-STATES PREVENTIVE SERVICES TASK-FORCE RECOMMENDATIONS

Background. The 1989 recommendations of the US Preventive Services Tas k Force (USPSTF) represent an emerging consensus about which clinical preventive services should be delivered. However, practicing physician s disagree with a number of the recommendations in the Task Force prev ention guidelines, and the reasons for disagreement have not been wide ly explored. Methods. A survey questionnaire assessing physician agree ment or disagreement with the USPSTF recommendations was sent to all 1 784 active members of the Ohio Academy of Family Physicians in October 1990. A factor analysis was performed on the items with which at leas t 5% of physicians disagreed. Associations of physician demographics a nd attitudes with the factor scores were then examined. Results. At le ast 5% of the 898 responding physicians disagreed with 67 of 150 USPST F recommendations. Physicians disagreed with the USPSTF recommendation s in three ways: (1) they believed that screening for some cancers is appropriate, even though not recommended by the USPSTF; (2) they belie ved that screening for other diseases in some populations is appropria te, even though not recommended by the USPSTF; and (3) they disagreed with some USPSTF recommendations for screening that is considered time -consuming or intrusive. Further analyses showed that practice setting and experience with the USPSTF guidelines were predictive of all thre e disagreement factors. Physician age, race, residency training, and r easons for disagreement were associated with two of the three factors. Conclusions. Physician disagreement with the USPSTF recommendations w as not random but clustered into three distinct factors. An opportunit y exists to design educational interventions for targeted subgroups of physicians. The views of practicing physicians should be incorporated into future guidelines.