PROVISION OF PREVENTIVE CARE TO UNANNOUNCED STANDARDIZED PATIENTS

Objective: To examine the relation between physician, training and pra ctice characteristics and the provision of preventive care as describe d in the guidelines of the Canadian Task Force on the Periodic Health Examination. Design: Cross-sectional study. Setting: Family practices open to new patients within 1 hour's drive of Hamilton, Ont. Participa nts: A total of 125 family physicians were randomly selected from resp ondents to an earlier preventive care survey. Of the 125, 44 (35.2%) d eclined to participate, and an additional 19 (15.2%) initially consent ed but later withdrew when they closed their practices to new patients . Sixty-two physicians thus participated in the study. Intervention: U nannounced standardized patients posing as new patients to the practic e visited study physicians' practices between September 1994 and Augus t 1995, portraying 4 scenarios: 48-year-old man, 70-year-old man, 28-y ear-old woman and 52-year-old woman. Outcome measures: Proportion of p reventive care manoeuvres carrying grade A, B, C, D and E recommendati ons from the Canadian Task Force on the Periodic 1 Health Examination that were performed, offered or advised. A standard score was computed based on the performance of grade A and B manoeuvres (good or fair ev idence for inclusion in the periodic health examination) and the nonpe rformance of grade D and E manoeuvres (fair or good evidence for exclu sion from the periodic health examination). Results: Study physicians performed or offered 65.6% of applicable grade A manoeuvres, 31.0% of grade B manoeuvres, 22.4% of grade C manoeuvres, 21.8% of grade D mano euvres and 4.9% of grade E manoeuvres. The provision of evidence-based preventive care was associated with solo (v. group) practice and capi tation or salary (v. fee-for-service) payment method. Preventive care performance was unrelated to physician's sex, certification in family medicine or problem-based (v. traditional) medical school curriculum. Conclusions: Preventive care guidelines of the Canadian Task Force on the Periodic Health Examination have been incompletely integrated into clinical practice. Research is needed to identify and reduce barriers to the provision of preventive care and to develop and apply effectiv e processes for the creation, dissemination and implementation of clin ical practice guidelines.