IMPROVING PREVENTIVE HEALTH-CARE IN A MEDICAL RESIDENT PRACTICE

Background: The ambulatory care resident practice is an opportunity to enhance the skills, knowledge, and attitudes for effective provision of preventive health services (PI-IS). Objective: To determine whether a required intervention at a university medical resident practice wou ld lead to improved performance of 6 secondary PHS. Methods: A sequent ially randomized chart analysis was performed at 2 clinics, a collabor ative nurse practitioner practice (NP) and a resident practice (RP) to determine performance rate of secondary PHS (pelvic, prostate, and br east examinations, stool guaiac testing, mammography, and prostate-spe cific antigen determination). A significantly lower (36.9%) PHS perfor mance rate was noted in the RP compared with 84.5% in NP for all 6 sec ondary Pi-IS studied. An intervention was implemented in the RP: follo wing every resident-patient clinic encounter a discussion and document ation of the patient's PHS status was required as part of the assessme nt and plans of management. At the end of 1 year the effect of this in tervention on performance rates of the 6 PHS in the RP was analyzed. R esults: There was a statistically significant difference (P<.001) betw een the PHS performance rates of NP and RP at the beginning. The inter vention resulted in improved PHS performance rates in the RP; compared with the NP at the end of the study no statistical difference was not ed between the groups. Conclusions: Despite various task force recomme ndations, PI-IS performance rates are generally suboptimal in varied c linic settings, including those of resident practices in teaching hosp itals. Physicians and residents believe in the importance of health ma intenance but fall short of their ideal in practice. Interventions to improve performance rates have been described; we are detailing a simp le, inexpensive, and practical method that achieved positive results.