Physiciansʹ attitudes and preventive care delivery: insights from the DOPC study

Background. Interventions that modify physician attitudes to enhance preventive service delivery are common, yet other factors may be relatively more important in determining whether these services are provided. We assessed associations between physiciansʹ attitudes and delivery of preventive care, compared with factors related to the patient, visit, or practice. Methods. One hundred twenty-eight primary care physicians rated the importance of five preventive services and their effectiveness at delivering them. We assessed whether their patients had received cervical smears, prostate-specific antigen (PSA) testing, smoking cessation advice, recommendation to use aspirin to prevent myocardial infarction, or weight-maintenance counseling, when appropriate. Multilevel models assessed associations between physician attitudinal characteristics and a patientʹs likelihood of being up to date for each service. Results. Importance of PSA screening and tobacco cessation counseling were weakly associated with patientsʹ receipt of preventive care; no association between attitudes and other services was observed. Factors such as having a visit for well care and use of prevention flowcharts were associated with delivery of preventive services to a greater extent. Conclusions. Physiciansʹ attitudes toward prevention are necessary, but not sufficient in ensuring the delivery of preventive services. Future interventions should address visit- and practice-specific factors more closely associated with preventive care.