Estimated time spent on preventive services by primary care physicians

Abstract

BackgroundDelivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services.MethodsWe analyzed a large dataset of primary care (family and internal medicine) visits using the National Ambulatory Medical Care Survey (2001–4); analyses were conducted 2007–8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates.ResultsPreventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively). New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA), cholesterol, Papanicolaou (Pap) smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence") services, tobacco cessation and Pap smear (in preventive visits), and one "B" rated ("at least fair evidence") service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness"), PSA and exercise counseling.ConclusionEven with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.

The “ins” and “outs” of Provider-Parent Communication: Perspectives From Adolescent Primary Care Providers on Challenges to Forging Alliances to Reduce Adolescent Risk

“…There seems to be sufficient evidence in the published data that support Dr Litt's claim, confirming the positive influence of parental involvement in a range of health and wellness behaviors [2,3], such as helping to decrease alcohol and tobacco use [4,5], delaying the age of sexual initiation [6 -8], improving physical activity levels [9,10], and guiding adolescents to make decisions related to vaccination [11]. Given the limited time and competing clinical demands common to most primary care practice settings [12,13], several barriers must be overcome so as to maximize the potential of this new era. The foremost among these barriers for adolescent primary health care providers is the challenge in achieving a delicate balance between the need to protect the confidentiality of their adolescent patients while enhancing parental involvement.…”

Functional Roles and Foundational Characteristics of Psychologists in Integrated Primary Care

“…Considering the volume of patients seen in primary care, the team-based approach is essential. Individual primary care physicians with a panel of 2,500 patients do not have the estimated 10.6 hours a day necessary to attend to the guideline recommendations for the 10 most common chronic diseases (Ostbye et al, 2005;Pollak et al, 2008). In PCMHs, physician lead teams that can include office staff, physician assistants, advanced nurse practitioners, care managers, behavioral health specialists, dieticians, and pharmacists (Hunter & Goodie, 2010).…”

Primary care providers' sources and preferences for cognitive health information in the United States

“…Primary care providers are also at the forefront of treating metabolic and cardiovascular diseases, which are among the leading risk factors for cognitive decline (Rabins, 2007). However, providers face the challenges of keeping current with health and medical information, and trying to fit preventive counseling into patient visits (Pollak et al, 2008;Yarnall et al, 2009). As evidence associating healthy behaviors with cognitive health grows, it is useful to identify effective methods to disseminate this research to health-care providers, in ways that are convenient and useful to them in their daily practice.…”