title: How do providers prioritize prevention? A qualitative study.
abstract: BACKGROUND
  Preventive care is an essential element of comprehensive primary care medicine, yet many providers do not address the full range of recommended preventive care services. There is little understanding of how, during time-constrained clinical encounters, providers prioritize preventive care services.
  
  
  OBJECTIVE
  To identify and compare how Department of Veterans Affairs (VA) primary care providers (PCPs) prioritized general preventive care services, including HIV testing.
  
  
  METHODS
  A semistructured, qualitative interview design.
  
  
  METHODS
  We conducted semistructured phone interviews with 31 PCPs across 2 urban VA facilities. Interviews entailed questions about the most common preventive care services in primary care, how decisions are made to address some preventive care services but not others, and the role of clinical reminders (CRs) in prioritizing care. Interviews were audio-recorded and transcribed verbatim. We conducted an iterative thematic analysis of interview transcripts, utilizing NVivo 8, a qualitative data management and coding software.
  
  
  RESULTS
  Most PCPs indicated they did not utilize CRs as a primary means of prioritizing general preventive care. Instead, PCPs prioritized general preventive care by attending to patients' individual needs and/or keeping in mind influential clinical training experiences. Prioritizing HIV testing included 1 or a combination of the following strategies: being attuned to HIV risk factors prior to the appearance of the CR, being prompted by the CR, and having a positive attitude toward CR design.
  
  
  CONCLUSIONS
  Prioritizing preventive care can be accomplished using various strategies, including CRs. Healthcare systems might benefit from encouraging PCPs to use a range of strategies.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, ENRM VA Hospital (152), 200 Springs Rd, Bedford, MA 01730. E-mail: Jeffrey.Solomon@va.gov.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Solomon
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Nora
authors.initials: N
authors.lastname: Meuller
authors.forename: Colin M
authors.initials: CM
authors.lastname: Thomas
authors.forename: John M
authors.initials: JM
authors.lastname: Stevens
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Bokhour
mesh_terms: D005260:Female; D006282:Health Personnel; D006292:Health Priorities; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011322:Primary Prevention; D036301:Qualitative Research; D017010:Reminder Systems; D014481:United States; D014493:United States Department of Veterans Affairs