Direct observation of rates of preventive service delivery in community family practice

Background. Data on preventive service delivery in primary care practice ha ve been limited by indirect methods of measurement. This study describes di rectly observed rates of preventive service delivery during outpatient visi ts to community family physicians. Methods. In a multimethod cross-sectional study, research nurses directly o bserved consecutive patient visits in the offices of 138 family physicians in Northeast Ohio. Patient eligibility for services recommended by the U.S. Preventive Services Task Force was determined from medical record review. Service delivery was assessed by direct observation of outpatient visits. R ates of delivery of specific preventive services were computed. Global summ ary measures were calculated for health habit counseling, screening, and im munization services. Results, Among 4,049 visits by established patients with available medical records, wide variation was observed among rates of different preventive se rvices delivered during well-care visits. During illness visits, rates were uniformly low for all preventive services. Counseling services were delive red at only slightly lower rates during illness visits compared to well vis its. Patients were up to date on 55% of screening, 24% of immunization, and 9% of health habit counseling services. Conclusion, Rates of preventive service delivery are low. Illness visits ar e important opportunities to deliver preventive services, particularly heal th habit counseling, to patients. Preventive service delivery summary score s are useful in providing a patient population perspective on the delivery of preventive services and in focusing attention on delivery of a comprehen sive portfolio of services. (C) 2000 American Health Foundation and Academi c Press.