Primary Care

Doctors can use conversational techniques during an illness visit to create an opportunity to deliver preventive care

Delivery of preventive care is low. Only 55 percent of patients are up-to-date with age-appropriate screening tests, less than 25 percent are up-to-date with immunizations, and less than 10 percent are receiving counseling about health habits such as smoking and diet. Most patients see doctors for acute or chronic care rather than preventive care. However, doctors can take advantage of these illness visits to deliver preventive care, suggests a study supported by the Agency for Healthcare Research and Quality (HS08776).

Researchers at the University of Medicine and Dentistry of New Jersey analyzed conversational techniques used by 53 primary care clinicians during 1,620 patient encounters at 18 family practices to deliver four preventive services during illness visits. These services included smoking cessation counseling, immunizations, mammography, and cervical cancer screening.

In the majority of cases, doctors did not deliver preventive care during illness visits. In 17 percent of illness visits, clinicians delivered at least one preventive service. Analysis of these cases led to identification of two routine strategies used by clinicians to initiate a discussion about prevention during illness visits. Some doctors used the close of the medical encounter to make arrangements for followup preventive care or give reminders about immunizations or screening tests (used for 0.23 to 6.38 percent of eligible patients).

Others took several steps during the conversation to switch from talk about the patient's presenting problem and to offer advice about relevant health habits (used for 1.33 to 7.63 percent of eligible patients). Individuals treated by clinicians who used these techniques to deliver preventive care during illness visits were more likely to receive smoking cessation counseling and be up to date on cervical cancer screening than patients seen by clinicians who did not use them.

See "Opportunistic approaches for delivering preventive care in illness visits," by Deborah Cohen, Ph.D., Barbara DiCicco-Bloom, Ph.D., R.N., Pamela Ohman Strickland, Ph.D., and others, in Preventive Medicine 38, pp. 565-573, 2004.

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