HOW DO FAMILY PHYSICIANS PRIORITIZE DELIVERY OF MULTIPLE PREVENTIVE SERVICES

Background. In spite of the recommendations of experts, little is know n about the priority that physicians assign to various preventive serv ices provided to patients within the time pressures and competing dema nds 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 prev entive services they would provide during 5 minutes remaining at the e nd of an illness visit for sinusitis, and during a visit for a 30-minu te physical examination. Descriptive analyses rank ordered the most co mmonly provided services. Additional analyses using chi-square and ana lysis of variance were used to characterize physicians who performed h igh and low levels of services recommended and not recommended by the US Preventive Services Task Force (USPSTF). Results. Among 268 respond ing physicians, more than 50% provided smoking cessation advice, blood pressure, height, and weight measurements, and the scheduling of a re turn visit during the illness visit. During a physical examination vis it, many other services, including breast examination, Papanicolaou te st, pelvic examination, and ordering a mammogram were also commonly ch osen. Physicians performing a high level of USPSTF-recommended prevent ive services and a low level of not recommended services were characte rized by their young age, residency training, not being in solo practi ce, and greater experience with USPSTF recommendations. Conclusions. P hysicians offer more preventive services during patient visits for phy sical examinations than during visits for illness. Physician character istics associated with the delivery of recommended levels of preventiv e services may be useful in identifying interventions that will direct medical resources toward the most effective preventive services.