PATIENT AND VISIT CHARACTERISTICS ASSOCIATED WITH OPPORTUNISTIC PREVENTIVE SERVICES DELIVERY

BACKGROUND. This study's purpose was to identify patient and visit cha racteristics associated with the use of illness visits as opportunitie s for the delivery of preventive services and to determine if time is allocated differently dur ing illness visits that make use of these op portunities. METHODS. Research nurses directly observed the delivery o f preventive services during consecutive patient visits on 2 separate days in the offices of 138 family physicians. Data on patient eligibil ity for preventive services were collected by medical record review. T ime use during patient visits was categorized using the Davis Observat ion Code (DOC). Patient characteristics, visit characteristics, and ti me use were compared during illness visits in which at least one servi ce recommended by the US Preventive Services Task Force was delivered to eligible patients, compared with illness visits during which no rec ommended preventive services were delivered. RESULTS. Preventive servi ces were delivered during 32% of 3547 illness visits. Adults, overweig ht patients, those who smoke or drink alcohol, new patients, and patie nts with fewer visits in the past year were more likely to receive pre ventive services. Patient request was also associated with increased d elivery of preventive services. The presence of another family member, visits for an acute illness, and the prescription of a drug were asso ciated with a decreased likelihood of a patient's receiving preventive services. When preventive services were delivered during illness visi ts, less time was spent on chatting, procedures, and physical examinat ion, and more time was spent on history-taking.CONCLUSIONS. Family phy sicians take greater advantage of opportunities for the delivery bf pr eventive services during the illness visits of high-risk patients. The results of our study suggest strategies that could be used to expand the opportunistic delivery of preventive services to other patients an d types of visits.