BY CINDY BORGMEYER
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Prevention: It's a topic you'd figure family physicians would know quite a lot about. And so they do, according to the results of pre- and post-intervention surveys for the 2003 Annual Clinical Focus on prevention.
ACF is the Academy's yearlong educational program designed to bring state-of-the-art information and resources on specific medical topics to AAFP members. The 2003 initiative covered four areas: primary, secondary and tertiary preventive issues, as well as prevention of medical errors.
"Overall, the results look encouraging," said Stephen Spann, M.D., of Houston, medical director of the ACF program. Spann acknowledged, though, that some results were mixed, perhaps reflecting the inherent difficulty of keeping up with a continual influx of new research findings and practice recommendations.
For example, family physicians' confidence in their ability to identify risk factors for common diseases and to initiate appropriate primary prevention strategies rose after completing the 2003 ACF. However, their confidence in their knowledge of current vaccines and immunization recommendations dipped slightly.
"The childhood immunization schedule, in particular, is getting increasingly complex," Spann noted, "and this may simply mean people are coming to grips with that."
Surveys yield few surprises
In November 2002, the Academy surveyed members about their current and desired knowledge and performance levels on various prevention topics. Of the 2,000 members contacted, 322 returned completed surveys, for a 16 percent response rate.
AAFP sent a follow-up survey in April 2004, after completion of the 2003 ACF activities on prevention. Again, 2,000 surveys were sent; this time, 227 members responded, yielding an 11 percent response rate.
Survey questions about secondary prevention focused chiefly on physicians' confidence in their knowledge of clinical screening guidelines and their ability to use those guidelines to develop and implement clinical prevention strategies. Respondents reported improvements in these areas, also noting an increased level of comfort about working in their communities to provide a primary care approach to disease prevention through use of clinical preventive services programs.
Respondents also reported increased confidence in their ability to implement intervention strategies in three key areas of tertiary prevention. Those areas: preventing complications of cardiovascular disease, managing asthma and preventing complications of diabetes.
For the first time, the ACF surveys included queries about quality improvement activities -- namely, protocols aimed at ensuring patient safety by avoiding medical errors. Members said they gained greater confidence in implementing specific steps of a QI program, such as documenting medication allergies in patient records, following up on lab tests and procedures ordered, and discussing the relative harms and benefits of screening tests with patients. One finding was somewhat surprising, Spann said: Although nearly 60 percent of respondents answered yes when asked if the 2003 ACF had heightened their awareness of prevention-related educational programs or their interest in pursuing such opportunities, almost 40 percent said no.
"Family doctors are pretty well-trained in prevention," Spann pointed out, "and perhaps felt they didn't need to go into more depth." This finding in particular presents an opportunity for further study to explore whether additional training would enhance patient outcomes, he added.
ACF gets vote of confidence
Members expressed resounding support for the ACF initiative, with nearly 90 percent of respondents affirming the AAFP's decision to devote educational resources to the program each year.
ACF 2003 was developed in cooperation with the Agency for Healthcare Research and Quality, American Cancer Society, American College of Preventive Medicine, American Diabetes Association, American Heart Association, CDC, National Cancer Institute, and NIH's National Human Genome Research Institute.
The 2003 initiative was supported by educational grants from Schering, Pharmacia Corp. (now Pfizer), Aventis Pharmaceuticals, GlaxoSmithKline, Abbott Laboratories, Wyeth Pharmaceuticals, Aventis Pasteur Inc. and AstraZeneca.
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
FP Report is published by the
AAFP News Department.
Copyright © 2004 by
American Academy of Family Physicians.
