Physicians' attitudes and preventive care delivery: insights from the DOPC study.
BACKGROUND
Interventions that modify physician attitudes to enhance preventive service delivery are common, yet other factors may be relatively more important in determining whether these services are provided. We assessed associations between physicians' attitudes and delivery of preventive care, compared with factors related to the patient, visit, or practice.


METHODS
One hundred twenty-eight primary care physicians rated the importance of five preventive services and their effectiveness at delivering them. We assessed whether their patients had received cervical smears, prostate-specific antigen (PSA) testing, smoking cessation advice, recommendation to use aspirin to prevent myocardial infarction, or weight-maintenance counseling, when appropriate. Multilevel models assessed associations between physician attitudinal characteristics and a patient's likelihood of being up to date for each service.


RESULTS
Importance of PSA screening and tobacco cessation counseling were weakly associated with patients' receipt of preventive care; no association between attitudes and other services was observed. Factors such as having a visit for well care and use of prevention flowcharts were associated with delivery of preventive services to a greater extent.


CONCLUSIONS
Physicians' attitudes toward prevention are necessary, but not sufficient in ensuring the delivery of preventive services. Future interventions should address visit- and practice-specific factors more closely associated with preventive care.
Litaker
David
D
Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA. David.Litaker@med.va.gov
Flocke
Susan A
SA
Frolkis
Joseph P
JP
Stange
Kurt C
KC
D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000592:standards*; D037001:Directive Counseling; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D019370:Observation; D010820:Physicians / Q000592:standards*; D011314:Preventive Health Services / Q000592:standards*; D011320:Primary Health Care