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Physician and Patient Predictors of Health Maintenance Visits
John S. Preisser, PhD;
Stuart J. Cohen, EdD;
James L. Wofford, MD;
William P. Moran, MD;
Brent J. Shelton, PhD;
Maureen W. McClatchey, PhD;
Pamela Wolfe, MS
Arch Fam Med. 1998;7:346-351.
Background Because of a strong association between health maintenance visits (HMVs) and cancer screening, knowledge of the predictors of an HMV have implications for screening.
Objective To examine the association of an HMV with patient, physician, and practice characteristics in the primary care setting.
Design A statewide study of cancer screening was conducted in Colorado to determine concordance with the National Cancer Institute's guidelines for screening for breast, cervical, prostate, and skin cancer. Medical records from patients were randomly chosen from primary care practices. Predictors of an HMV were determined by fitting a logistic model to baseline data, adjusting for the cluster sampling of patients within practices.
Setting Nonacademic primary care practices in Colorado.
Participants A total of 5746 patients aged 42 to 74 years from 132 primary care practices.
Main Outcome Measure Whether a patient had an HMV in the previous year.
Results Of all patients, 31% had an HMV in the previous year. Patient characteristics associated with having HMVs included nonsmoking status, odds ratio (OR) (95% confidence interval [CI]) of 1.27 (1.11-1.46), age, and sex. Women aged 50 to 69 years were significantly more likely to have an HMV than men aged 50 to 69 years (OR, 1.30; 95% CI, 1.10-1.54). Among adults aged 70 years and older, there were no significant sex differences in receiving HMVs. Physician and practice characteristics associated with providing HMVs included practice size ( 3 full-time physicians) (OR, 1.34; 95% CI, 1.01-1.77), physician contemplation of changing approaches to cancer screening (OR, 1.33; 95% CI, 1.04-1.70), and physician female sex (OR, 1.33; 95% CI, 1.04-1.70). Physician age and specialty (general internist or family physician) were not associated with the level of health maintenance delivery.
Conclusion Certain subgroups, such as smokers, patients in smaller practices, and physicians not yet considering changing their approach to cancer screening, could be targeted in future intervention studies designed to provide preventive services in primary care settings.
From the Health Services Research Center, Department of Public Health Sciences (Drs Preisser, Cohen, Moran, and Shelton), and the Department of Internal Medicine (Drs Cohen, Wofford, and Moran), Wake Forest University School of Medicine, Winston-Salem, NC; and the Division of Biostatistics, AMC Cancer Research Center (Drs Cohen and McClatchey and Ms Wolfe), Denver, Colo. Dr McClatchey is now with the Kempe Prevention Research Center for Family and Child Health, Denver.
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