PRIMARY-CARE PRACTICE ORGANIZATION AND PREVENTIVE SERVICES DELIVERY -A QUALITATIVE-ANALYSIS

BACKGROUND. Rapid developments within the health care environment have led to increased pressures for change among primary care physicians a nd their practices. Nevertheless, a lack of understanding of practice organization and function has limited the effectiveness of attempts to change practice behaviors. Recent attempts to increase the delivery o f preventive health care services illustrate the limitations of curren t approaches. To assist physicians in their attempts at change, our st udy looked at the office as a whole system and at the competing demand s within the primary care setting. METHODS. Qualitative fieldnotes wer e recorded by research nurses who observed 138 family physicians in 84 practices in northeast Ohio for 4 days each. These data were content- analyzed to identify features that are important for understanding how practices are organized. RESULTS. These data indicate that primary ca re practice is much more complex than research and transformation effo rts generally acknowledge. The data identified a diverse set of featur es that describe how primary care practices are organized and function . These included cognitive and behavioral components of physician phil osophy and style, and numerous features of the practice organization, such as office efficiency, clarity of staff roles, communication patte rns among physicians and staff, and approaches to using office protoco ls. The data also suggest that some practices are more innovative than others and that some physicians or staff have special motivations tha t can support or inhibit a particular change. CONCLUSIONS. Physicians who want to change their practice, as well as those persons who want t o stimulate change from the outside, need to have a more comprehensive approach than is now commonly used to assess practices that encompass a broad spectrum of variables.