PHYSICIAN AND PATIENT PREDICTORS OF HEALTH MAINTENANCE VISITS

Background: Because of a strong association between health maintenance visits (HMVs) and cancer screening, knowledge of the predictors of an HMV have implications for screening. Objective: To examine the associ ation of an HMV with patient, physician, and practice characteristics in the primary care setting. Design: A statewide study of cancer scree ning was conducted in Colorado to determine concordance with the Natio nal Cancer Institute's guidelines for screening for breast, cervical, prostate, and skin cancer. Medical records from patients were randomly chosen from primary care practices. Predictors of an HMV were determi ned by fitting a logistic model to baseline data, adjusting for the cl uster sampling of patients within practices. Setting: Nonacademic prim ary care practices in Colorado. Participants: A total of 5746 patients aged 42 to 74 years from 132 primary care practices. Main Outcome Mea sure: Whether a patient had an HMV in the previous year. Results: Of a ll patients, 31% had an HMV in the previous year. Patient characterist ics associated with having HMVs included nonsmoking status, odds ratio (OR) (95% confidence interval [CI]) of 1.27 (1.11-1.46), age, and sex . Women aged 50 to 69 years were significantly more likely to have an HMV than men aged SO to 69 years (OR, 1.30; 95% CI, 1.10-1.54). Among adults aged 70 years and older, there were no significant sex differen ces in receiving HMVs. Physician and practice characteristics associat ed with providing HMVs included practice size (greater than or equal t o 3 full-time physicians) (OR, 1.34; 95% CI, 1.01-1.77),physician cont emplation of changing approaches to cancer screening (OR, 1.33; 95% CI , 1.04-1.70), and physician female sex (OR, 1.33; 95% CI, 1.04-1.70). Physician age and specialty (general internist or family physician) we re not associated with the level of health maintenance delivery. Concl usion: Certain subgroups, such as smokers, patients in smaller practic es, and physicians not yet considering changing their approach to canc er screening, could be targeted in future intervention studies designe d to provide preventive services in primary care settings.