Abstract
BackgroundWhile physicians are key to primary preventive care, their delivery rate is sub-optimal. Assessment of physician beliefs is integral to understanding current behavior and the conceptualization of strategies to increase delivery.MethodsA focus group with regional primary care physician (PCP) Opinion Leaders was conducted as a formative step towards regional assessment of attitudes and barriers regarding preventive care delivery in primary care. Following the PRECEDE-PROCEED model, the focus group aim was to identify conceptual themes that characterize PCP beliefs and practices regarding preventive care. Seven male and five female PCPs (family medicine, internal medicine) participated in the audiotaped discussion of their perceptions and behaviors in delivery of primary preventive care. The transcribed audiotape was qualitatively analyzed using grounded theory methodology.ResultsThe PCPs' own perceived role in daily practice was a significant barrier to primary preventive care. The prevailing PCP model was the "one-stop-shop" physician who could provide anything from primary to tertiary care, but whose provision was dominated by the delivery of immediate diagnoses and treatments, namely secondary care.ConclusionsThe secondary-tertiary prevention PCP model sustained the expectation of immediacy of corrective action, cure, and satisfaction sought by patients and physicians alike, and, thereby, de-prioritized primary prevention in practice. Multiple barriers beyond the immediate control of PCP must be surmounted for the full integration of primary prevention in primary care practice. However, independent of other barriers, physician cognitive value of primary prevention in practice, a base mediator of physician behavior, will need to be increased to frame the likelihood of such integration.
Highlights
While physicians are key to primary preventive care, their delivery rate is suboptimal
The majority of primary care physicians concur with the preventive care guidelines issued by the 1996 United States Preventive Services Task Force, and agree that it is their responsibility to deliver preventive care services [3]
Members of the Advisory Board and Department of Family Medicine (DFM) applied their knowledge of the regional physician community and assisted in the identification of 19 Opinion Leaders among Family Practice, Internal Medicine, or General Practice primary care physicians (PCP) to be invited to participate in a semi-directed audiotaped focus group discussion
Summary
While physicians are key to primary preventive care, their delivery rate is suboptimal. The majority of primary care physicians concur with the preventive care guidelines issued by the 1996 United States Preventive Services Task Force, and agree that it is their responsibility to deliver preventive care services [3]. Despite the recommendation that preventive services be a part of every medical visit that was issued by the United States Preventive Services Task Force (1989 and 1996), studies report a compliance rate of only 20% to 60% [5,6,7]. 1990 estimates showed tobacco to be associated with 400,000 US total deaths. 300,000 deaths were related to diet and low physical activity patterns [9]
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