Practitioner provision of preventive care in general practice consultations: Association with patient educational and occupational status

Abstract

Socio-economically disadvantaged individuals experience significantly greater mortality and morbidity relative to advantaged individuals. General practitioners have been suggested to occupy a position which has the capacity to ameliorate the health consequences of socio-economic disadvantage. Community studies of preventive care status suggest, however, that socio-economically disadvantaged individuals are less likely to receive appropriate preventive care. Using a convenience sample of 22 general practitioners, 579 consultations were audiotaped to determine whether practitioner provision of preventive care was associated with the educational and occupational status of patients. Practitioner provision of preventive care was assessed in terms of: the proportion of consultations in which discussion of at least one preventive care topic occurred; the number of preventive care topics discussed; and the proportion of consultations in which each of six specific preventive care topics were discussed. Practitioners were significantly less likely to discuss at least one preventive care topic with patients of high occupational status. No significant differences were observed between patient groups in the number of preventive care topics discussed, and in the likelihood of receiving preventive care discussion concerning each of six preventive topics. However, a consistent trend of practitioners being less likely to discuss preventive care topics with patients of high educational or occupational status was evident for all outcome variables. The pattern of results suggests that previously reported findings of socio-economically disadvantaged individuals having a poorer preventive care status may not be attributable to differentials in practitioner's provision of preventive care. Greater attention should therefore be given to identifying and resolving barriers other than practitioner-based barriers to preventive care provision if these differentials in preventive care status are to be reduced.