Historical reflections on current preventive practice

Background. Preventive care in medicine and public health has evolved throu gh historical stages. Recently, developments within the contemporary health care environment have pressured primary care physicians to deliver more pr eventive care, but little was known about the actual delivery of such servi ces. The Direct Observation of Primary Care study investigated the delivery of preventive services. Methods. In the study's qualitative portion, research nurses observed 138 f amily physicians in northeast Ohio, dictating observational fieldnotes. Aft er transcription, the fieldnotes were content analyzed to identify patterns and themes. Further consideration led to a secondary historical analysis o f ideas influencing medicine and public health. Fieldnotes were then reanal yzed from a historical perspective. Results, The primary analysis showed variations among physician's philosoph ies and styles of practice that influenced the delivery of preventive servi ces. The secondary analysis highlighted competing historical ideas that hav e shaped medicine and public health. The authors argue that contemporary ph ysician's philosophies and styles of practice have parallels in the history of ideas informing medical and public health practice. Conclusions. The implications of these findings, particularly a lost apprec iation of ideas that continue to be operational in practice, may be importa nt if there is to be improvement in the delivery of preventive services. (C ) 2000 American Health Foundation and Academic Press.