OPPORTUNISTIC PREVENTIVE SERVICES DELIVERY - ARE TIME LIMITATIONS ANDPATIENT SATISFACTION BARRIERS

BACKGROUND. The use of illness visits as opportunities to increase the delivery of preventive services has been widely recommended, but its feasibility in community practice is not known. We examined the preval ence of this opportunistic approach to providing preventive services, and the degree to which patient satisfaction and time limitation are b arriers. METHODS. Consecutive patient illness visits to 138 community family physicians were directly observed. Visits by patients who recei ved at least one preventive service recommended by the US Preventive S ervices Task Force were compared with visits by patients not receiving any recommended preventive services, controlling for potentially conf ounding patient characteristics. RESULTS. Among 3547 illness visits, p reventive services were delivered during 39% of visits for chronic ill ness and 30% of visits for acute illness. Opportunistic health habits counseling occurred more frequently than screening or immunization. Vi sit satisfaction reported by 2454 patients using the Medical Outcomes Survey 9-item Visit Rating Scale was not different during illness visi ts with or without the delivery of preventive services. The duration o f illness visits that included preventive services was an average of 2 .1 minutes longer than illness visits without such interventions (95% confidence interval, 1.7 - 2.4). CONCLUSIONS. The delivery of preventi ve services during illness visits is common in community practice and is well accepted by patients. The expansion of an opportunistic approa ch to providing preventive services will require attention to time-eff icient approaches.