Millstein SG, Marcell AV; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Susan G. Millstein, Ph.D., Professor of Pediatrics, Department of Pediatrics, University of California, San Francisco, 3333 California Street, Suite 245, Box 0503, San Francisco, CA 94143-0503. Tel: 415-502-4852; Fax: 415-502-4858; E-mail: shana@itsa.ucsf.edu
Objectives: Most research on adolescent preventive services has focused on documenting the prevalence of screening and, to a lesser extent, counseling and educational services. There has been little emphasis on the quality of services delivered. Furthermore, although guidelines for adolescent preventive services highlight the importance of alcohol-related services, little work has been done in this area. Using a national sample of primary care pediatricians and family practitioners, we examined the quality of alcohol-related preventive counseling and education services delivered to adolescents in the US. Design: Study participants were recruited by mail using a specialty-stratified random sample drawn from the American Medical Association Masterfile. Sixty-three percent of eligible physicians participated (N=1,842). Data were collected via questionnaire. Physicians estimated the percentage of adolescent patients to whom they provided alcohol-related preventive education, and how often they used each of 10 intervention approaches that differed in terms of general effectiveness. An algorithm combining level of effectiveness of the interventions used and their frequency of use yielded a 7 level scale for categorizing the quality of physicians' education efforts. Multiple regression analyses were used to examine variations in quality as a function of physician factors (gender, year of medical school graduation, specialty, whether board certified, perceived competence in managing adolescent alcohol use) and environmental factors (type of practice, metropolitan vs. rural practice setting, % of practice managed care, % of Medicaid patients, availability of referral resources).Population Studied: Eligibility criteria were: primary specialty in pediatrics or family practice; actively practicing in US; spends at least 50% time in direct patient care; sees adolescent patients for routine visits.Principal Findings: The percentage of physicians providing high quality education/counseling (scoring 5 and above on quality index) was 44.6% (among female pediatricians), 33.9% (male pediatricians), 32.2% (female family practitioners), and 24.6% (male family practitioners). Using a p < .001 cutoff, variables associated with higher quality education included: being female; being pediatrician; having high perceived competence. When the assessment of preventive service provision focused only on examining the percentage of adolescents to whom physicians delivered alcohol-related preventive education, one-third of the sample could be considered to be providing high levels of service (providing alcohol education to 75% or more of their adolescent patients). But assessment of the quality of services provided by these physicians indicated that only one-half delivered educational interventions at quality levels 5 or higher. Conclusions: Although environmental factors are often cited as being important predictors of service provision, they do not emerge as predictors of quality. Comparisons of service provision using prevalence estimates and those using quality assessments identify different subsets of physicians who appear to be delivering high levels of preventive services. Implications for Policy, Delivery or Practice: The association of perceived competence and specialty to quality highlights the importance of physician factors and points to a potential role for medical education. Primary Funding Source: National Institute of Alcohol Abuse and Alcoholism (NIAAA)
Publication Types:
Keywords:
- Adolescent
- Adolescent Health Services
- Alcohol Drinking
- Alcoholism
- Child
- Counseling
- Educational Status
- Family Practice
- Female
- Health Education
- Humans
- Male
- Mass Screening
- Pediatrics
- Physicians
- Physicians, Family
- Primary Health Care
- Questionnaires
- Referral and Consultation
- Teaching
- education
- hsrmtgs
Other ID:
UI: 102272210
From Meeting Abstracts