title: Opportunistic approaches for delivering preventive care in illness visits.
abstract: OBJECTIVE
  To describe how clinicians create opportunities to deliver preventive care in illness visits and assess the impact this has on preventive service delivery.
  
  
  METHODS
  Detailed and descriptive fieldnotes were collected from 18 purposefully selected family practices, including direct observations of 53 primary care clinicians and 1620 patient encounters. Conversation analysis was used to examine the conversational techniques employed to deliver four preventive services (smoking counseling, immunization delivery, mammography, and cervical cancer screening) in illness visits. Qualitative data was coded and analyzed to assess impact on preventive service delivery rates.
  
  
  RESULTS
  Two methods for opportunistic preventive service delivery were observed. In the first, clinicians used the close of the medical encounter to make arrangement for follow-up preventive care. In the second approach, clinicians use a stepwise conversational device to exit talk about the patient's presenting problem and enter into relevant health habit advice. Quantitative analyses show that opportunistic methods are rarely used to deliver preventive services in illness visits. The stepwise technique was the most frequently used method. Patients treated by clinicians who used opportunistic techniques to deliver preventive care in illness visits were more likely to be up-to-date on smoking counseling and cervical cancer screening than those patients who were treated by clinicians who did not use opportunistic approaches.
  
  
  CONCLUSIONS
  Opportunistic preventive service delivery in illness visits can be an efficient and effective way to deliver preventive care. Although infrequently used, quantitative data suggest that the use of opportunistic approaches to deliver preventive services during illness visits can enhance preventive care rates. Interventions aimed at helping clinicians develop effective strategies for offering preventive care during illness visits may be an important complement to existing mechanical interventions that might, by themselves, be insufficient to improve preventive care.
authors.affiliation: Department of Family Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901-0019, USA. debbiec@nac.net
authors.forename: Deborah
authors.initials: D
authors.lastname: Cohen
authors.forename: Barbara
authors.initials: B
authors.lastname: DiCicco-Bloom
authors.forename: Pamela Ohman
authors.initials: PO
authors.lastname: Strickland
authors.forename: Adrienne
authors.initials: A
authors.lastname: Headley
authors.forename: John
authors.initials: J
authors.lastname: Orzano
authors.forename: Jeffery
authors.initials: J
authors.lastname: Levine
authors.forename: John
authors.initials: J
authors.lastname: Scott
authors.forename: Benjamin
authors.initials: B
authors.lastname: Crabtree
mesh_terms: D005194:Family Practice / Q000458:organization & administration*; D006801:Humans; D009819:Office Visits; D011314:Preventive Health Services / Q000458:organization & administration*; D014481:United States