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Prioritization of Evidence-Based Preventive Health Services During Periodic Health Examinations

      Background

      Delivery of preventive services sometimes falls short of guideline recommendations.

      Purpose

      To evaluate the multilevel factors associated with evidence-based preventive service delivery during periodic health examinations (PHEs).

      Methods

      Primary care physicians were recruited from an integrated delivery system in southeast Michigan. Audio recordings of PHE office visits conducted from 2007 to 2009 were used to ascertain physician recommendation for or delivery of 19 guideline-recommended preventive services. Alternating logistic regression was used to evaluate factors associated with service delivery. Data analyses were completed in 2011.

      Results

      Among 484 PHE visits to 64 general internal medicine and family physicians by insured patients aged 50–80 years, there were 2662 services for which patients were due; 54% were recommended or delivered. Regression analyses indicated that the likelihood of service delivery decreased with patient age and with each concern the patient raised, and it increased with increasing BMI and with each additional minute after the scheduled appointment time the physician first presented. The likelihood was greater with patient–physician gender concordance and less if the physician used the electronic medical record in the exam room or had seen the patient in the past 12 months.

      Conclusions

      A combination of patient, patient-physician relationship, and visit contextual factors are associated with preventive service delivery. Additional studies are warranted to understand the complex interplay of factors that support and compromise preventive service delivery.
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      References

        • Mehrotra A.
        • Zaslavsky A.M.
        • Ayanian J.Z.
        Preventive health examinations and preventive gynecological examinations in the U.S..
        Arch Intern Med. 2007; 167: 1876-1883
        • Prochazka A.V.
        • Lundahl K.
        • Pearson W.
        • Oboler S.K.
        • Anderson R.J.
        Support of evidence-based guidelines for the annual physical examination: a survey of primary care providers.
        Arch Intern Med. 2005; 165: 1347-1352
        • Oboler S.K.
        • Prochazka A.V.
        • Gonzales R.
        • Xu S.
        • Anderson R.J.
        Public expectations and attitudes for annual physical examinations and testing.
        Ann Intern Med. 2002; 136: 652-659
        • Canadian Task Force
        Canadian Task Force on the PHE.
        CMAJ. 1979; 121: 1193-1224
      1. Periodic health examination: a guide for designing individualized preventive health care in the asymptomatic patients.
        Ann Intern Med. 1981; 95: 729-732
        • Boulware L.E.
        • Barnes G.J.
        • Wilson R.F.
        • et al.
        Value of the periodic health evaluation.
        Evid Rep Technol Assess (Full Rep). 2006; : 1-134
        • Fenton J.J.
        • Cai Y.
        • Weiss N.S.
        • et al.
        Delivery of cancer screening: how important is the preventive health examination?.
        Arch Intern Med. 2007; 167: 580-585
        • Ferrante J.M.
        • Balasubramanian B.A.
        • Hudson S.V.
        • Crabtree B.F.
        Principles of the patient-centered medical home and preventive services delivery.
        Ann Fam Med. 2010; 8: 108-116
        • Lafata J.E.
        • Williams L.K.
        • Ben Menachem T.
        • Moon C.
        • Divine G.
        Colorectal carcinoma screening procedure use among primary care patients.
        Cancer. 2005; 104: 1356-1361
        • Zapka J.G.
        • Puleo E.
        • Vickers-Lahti M.
        • Luckmann R.
        Healthcare system factors and colorectal cancer screening.
        Am J Prev Med. 2002; 23: 28-35
        • Stange K.C.
        • Flocke S.A.
        • Goodwin M.A.
        • Kelly R.B.
        • Zyzanski S.J.
        Direct observation of rates of preventive service delivery in community family practice.
        Prev Med. 2000; 31: 167-176
        • Pollak K.I.
        • Krause K.M.
        • Yarnall K.S.
        • Gradison M.
        • Michener J.L.
        • Ostbye T.
        Estimated time spent on preventive services by primary care physicians.
        BMC Health Serv Res. 2008; 8: 245
        • Yarnall K.S.
        • Pollak K.I.
        • Ostbye T.
        • Krause K.M.
        • Michener J.L.
        Primary care: is there enough time for prevention?.
        Am J Public Health. 2003; 93: 635-641
        • Yarnall K.S.
        • Ostbye T.
        • Krause K.M.
        • Pollak K.I.
        • Gradison M.
        • Michener J.L.
        Family physicians as team leaders: “time” to share the care.
        Prev Chronic Dis. 2009; 6: A59
        • Abbo E.D.
        • Zhang Q.
        • Zelder M.
        • Huang E.S.
        The increasing number of clinical items addressed during the time of adult primary care visits.
        J Gen Intern Med. 2008; 23: 2058-2065
        • Nutting P.A.
        • Baier M.
        • Werner J.J.
        • Cutter G.
        • Conry C.
        • Stewart L.
        Competing demands in the office visit: what influences mammography recommendations?.
        J Am Board Fam Pract. 2001; 14: 352-361
        • Jaen C.R.
        • McIlvain H.
        • Pol L.
        • Phillips Jr, R.L.
        • Flocke S.
        • Crabtree B.F.
        Tailoring tobacco counseling to the competing demands in the clinical encounter.
        J Fam Pract. 2001; 50: 859-863
        • Nutting P.A.
        • Rost K.
        • Smith J.
        • Werner J.J.
        • Elliot C.
        Competing demands from physical problems: effect on initiating and completing depression care over 6 months.
        Arch Fam Med. 2000; 9: 1059-1064
        • Jaen C.R.
        • Stange K.C.
        • Nutting P.A.
        Competing demands of primary care: a model for the delivery of clinical preventive services.
        J Fam Pract. 1994; 38: 166-171
        • Wunderlich T.
        • Cooper G.
        • Divine G.
        • et al.
        Inconsistencies in patient perceptions and observer ratings of shared decision making: the case of colorectal cancer screening.
        Patient Educ Couns. 2010; 80: 358-363
        • Lafata J.E.
        • Cooper G.
        • Divine G.
        • et al.
        Patient-physician colorectal cancer screening discussions: delivery of the 5A’s in practice.
        Am J Prev Med. 2011; 41: 480-486
      2. Flocke S, Stange KC, Cooper GS, et al. Patient preferences and receipt of information for colorectal cancer screening. Cancer Bio EPI.

        • Deyo R.A.
        • Cherkin D.C.
        • Ciol M.A.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • D'Agostino Sr, R.B.
        • Vasan R.S.
        • Pencina M.J.
        • et al.
        General cardiovascular risk profile for use in primary care: the Framingham Heart Study.
        Circulation. 2008; 117: 743-753
        • CDC
        Behavioral Risk Factor Surveillance System Questionnaire.
        2006
        • Vinson D.C.
        • Galliher J.M.
        • Reidinger C.
        • Kappus J.A.
        Comfortably engaging: which approach to alcohol screening should we use?.
        Ann Fam Med. 2004; 2: 398-404
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        • Lowe B.
        An ultra-brief screening scale for anxiety and depression: the PHQ-4.
        Psychosomatics. 2009; 50: 613-621
        • Pinsky P.F.
        • Kramer B.S.
        • Reding D.
        • Buys S.
        Reported family history of cancer in the prostate, lung, colorectal, and ovarian cancer screening trial.
        Am J Epidemiol. 2003; 157: 792-799
        • Street Jr, R.L.
        • Millay B.
        Analyzing patient participation in medical encounters.
        Health Commun. 2001; 13: 61-73
        • Gordon H.S.
        • Street Jr, R.L.
        • Sharf B.F.
        • Souchek J.
        Racial differences in doctors' information-giving and patients' participation.
        Cancer. 2006; 107: 1313-1320
        • Backer E.L.
        • Gregory P.
        • Jaen C.R.
        • Crabtree B.F.
        A closer look at adult female health care maintenance visits.
        Fam Med. 2006; 38: 355-360
        • Kottke T.E.
        • Solberg L.I.
        • Brekke M.L.
        • Cabrera A.
        • Marquez M.A.
        Delivery rates for preventive services in 44 midwestern clinics.
        Mayo Clin Proc. 1997; 72: 515-523
        • Sussman A.L.
        • Williams R.L.
        • Leverence R.
        • Gloyd Jr, P.W.
        • Crabtree B.F.
        The art and complexity of primary care clinicians' preventive counseling decisions: obesity as a case study.
        Ann Fam Med. 2006; 4: 327-333
        • Litaker D.
        • Flocke S.A.
        • Frolkis J.P.
        • Stange K.C.
        Physicians' attitudes and preventive care delivery: insights from the DOPC study.
        Prev Med. 2005; 40: 556-563
        • Zapka J.
        • Taplin S.H.
        • Price R.A.
        • Cranos C.
        • Yabroff R.
        Factors in quality care—the case of follow-up to abnormal cancer screening tests—problems in the steps and interfaces of care.
        J Natl Cancer Inst Monogr. 2010; 2010: 58-71
        • Wagner E.H.
        • Austin B.T.
        • Von Korff M.
        Improving outcomes in chronic illness.
        Manag Care Q. 1996; 4: 12-25
        • Carpiano R.M.
        • Flocke S.A.
        • Frank S.H.
        • Stange K.C.
        Tools, teamwork, and tenacity: an examination of family practice office system influences on preventive service delivery.
        Prev Med. 2003; 36: 131-140
        • Carney P.A.
        • Dietrich A.J.
        • Keller A.
        • Landgraf J.
        • O'Connor G.T.
        Tools, teamwork, and tenacity: an office system for cancer prevention.
        J Fam Pract. 1992; 35: 388-394
        • Shenson D.
        • Adams M.
        • Bolen J.
        Delivery of preventive services to adults aged 50–64: monitoring performance using a composite measure, 1997–2004.
        J Gen Intern Med. 2008; 23: 733-740
        • Gowin E.
        • Avonts D.
        • Horst-Sikorska W.
        • Ignaszak-Szczepaniak M.
        • Michalak M.
        Gender makes the difference: the influence of patients' gender on the delivery of preventive services in primary care in Poland.
        Qual Prim Care. 2009; 17: 343-350
        • Flocke S.A.
        • Gilchrist V.
        Physician and patient gender concordance and the delivery of comprehensive clinical preventive services.
        Med Care. 2005; 43: 486-492
        • Fiscella K.
        • Goodwin M.A.
        • Stange K.C.
        Does patient educational level affect office visits to family physicians?.
        J Natl Med Assoc. 2002; 94: 157-165
        • Henderson J.T.
        • Weisman C.S.
        Physician gender effects on preventive screening and counseling: an analysis of male and female patients' health care experiences.
        Med Care. 2001; 39: 1281-1292
        • Yancy Jr, W.S.
        • McDuffie J.R.
        • Stechuchak K.M.
        • et al.
        Obesity and receipt of clinical preventive services in veterans.
        Obesity (Silver Spring). 2010; 18: 1827-1835
        • Chang V.W.
        • Asch D.A.
        • Werner R.M.
        Quality of care among obese patients.
        JAMA. 2010; 303: 1274-1281
        • Peytremann-Bridevaux I.
        • Santos-Eggimann B.
        Use of preventive services of overweight and obese Europeans aged 50-79 years.
        J Gen Intern Med. 2007; 22: 923-929
        • Bertakis K.D.
        • Callahan E.J.
        A comparison of initial and established patient encounters using the Davis Observation Code.
        Fam Med. 1992; 24: 307-311
        • Weyer S.M.
        • Konrad N.
        • Esola D.
        • Goodwin M.A.
        • Stange K.C.
        • Flocke S.A.
        Features of medical records in community practices and their association with preventive service delivery.
        Med Care. 2005; 43: 28-33
        • Dubey V.
        • Mathew R.
        • Iglar K.
        • Moineddin R.
        • Glazier R.
        Improving preventive service delivery at adult complete health check-ups: the Preventive health Evidence-based Recommendation Form (PERFORM) cluster randomized controlled trial.
        BMC Fam Pract. 2006; 7: 44
        • Irani J.S.
        • Middleton J.L.
        • Marfatia R.
        • Omana E.T.
        • D'Amico F.
        The use of electronic health records in the exam room and patient satisfaction: a systematic review.
        J Am Board Fam Med. 2009; 22: 553-562
        • Nagy V.T.
        • Kanter M.H.
        Implementing the electronic medical record in the exam room: the effect on physician–patient communication and patient satisfaction.
        Perm J. 2007; 11: 21-24
        • Frankel R.
        • Altschuler A.
        • George S.
        • et al.
        Effects of exam-room computing on clinician–patient communication: a longitudinal qualitative study.
        J Gen Intern Med. 2005; 20: 677-682
        • Hsu J.
        • Huang J.
        • Fung V.
        • Robertson N.
        • Jimison H.
        • Frankel R.
        Health information technology and physician–patient interactions: impact of computers on communication during outpatient primary care visits.
        J Am Med Inform Assoc. 2005; 12: 474-480
        • Kottke T.E.
        • Brekke M.L.
        • Solberg L.I.
        Making “time” for preventive services.
        Mayo Clin Proc. 1993; 68: 785-791
        • Maciosek M.V.
        • Coffield A.B.
        • Edwards N.M.
        • Flottemesch T.J.
        • Goodman M.J.
        • Solberg L.I.
        Priorities among effective clinical preventive services: results of a systematic review and analysis.
        Am J Prev Med. 2006; 31: 52-61
        • Hawley S.T.
        • Volk R.J.
        • Krishnamurthy P.
        • Jibaja-Weiss M.
        • Vernon S.W.
        • Kneuper S.
        Preferences for colorectal cancer screening among racially/ethnically diverse primary care patients.
        Med Care. 2008; 46: S10-S16
        • Sheridan S.L.
        • Harris R.P.
        • Woolf S.H.
        Shared decision making about screening and chemoprevention: a suggested approach from the U.S. Preventive Services Task Force.
        Am J Prev Med. 2004; 26: 56-66
        • Reid R.J.
        • Fishman P.A.
        • Yu O.
        • et al.
        Patient-centered medical home demonstration: a prospective, quasi-experimental, before and after evaluation.
        Am J Manag Care. 2009; 15: e71-e87
        • Reid R.J.
        • Coleman K.
        • Johnson E.A.
        • et al.
        The group health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers.
        Health Aff (Millwood). 2010; 29: 835-843
        • Krist A.H.
        • Woolf S.H.
        A vision for patient-centered health information systems.
        JAMA. 2011; 305: 300-301
        • Lafata J.E.
        • Kolk D.
        • Peterson E.L.
        • et al.
        Improving osteoporosis screening: results from a randomized cluster trial.
        J Gen Intern Med. 2007; 22: 346-351
        • Gierisch J.M.
        • DeFrank J.T.
        • Bowling J.M.
        • et al.
        Finding the minimal intervention needed for sustained mammography adherence.
        Am J Prev Med. 2010; 39: 334-344
        • DeFrank J.T.
        • Rimer B.K.
        • Gierisch J.M.
        • Bowling J.M.
        • Farrell D.
        • Skinner C.S.
        Impact of mailed and automated telephone reminders on receipt of repeat mammograms: a randomized controlled trial.
        Am J Prev Med. 2009; 36: 459-467
        • Goodwin M.
        The Hawthorne effect in direct observation research with physicians and patients.
        Epidemiology & Biostatistics, Case Western Reserve University, Cleveland2001
        • Adair J.
        The Hawthorne effect: a reconsideration of the methodological artifact.
        J Appl Psychol. 1984; 69: 334-345
        • Jones S.
        Was there a Hawthorne effect?.
        Am J Sociol. 1992; 98: 451-468
        • Stange K.C.
        • Zyzanski S.J.
        • Smith T.F.
        • et al.
        How valid are medical records and patient questionnaires for physician profiling and health services research?.
        Med Care. 1998; 36: 851-867