Providing Preventive Services
Survey Spotlights Need for Improvements in Preventive Care
October 21, 2022, 8:35 a.m. News Staff — Although family physicians and other primary care clinicians are routinely expected to offer many of the services recommended by the U.S. Preventive Services Task Force, it can be difficult under the best of circumstances — especially considering that that the task force has more than 80 recommendations spread out among a dozen categories. The challenge can be even greater for family physicians in rural areas and other settings that have fewer resources and less access to integrated care.
To identify activities where clinicians would like to see improvement and more help with implementation, a team of researchers surveyed a sample of AAFP members, as well as the AAFP National Research Network and several other practice-based research networks across the country. Analysis of the survey results, published recently BMC Primary Care, showed that both rural and non-rural primary care clinicians feel a need for improvement, especially with primary prevention activities. The results also showed that clinicians feel a need for assistance with delivering the same types of prevention activities regardless of practice setting.
“These findings can help guide future quality improvement work between and collaborations with health research teams,” said Michaela Brtnikova, Ph.D., M.P.H., an instructor in the Department of Pediatrics at the University of Colorado School of Medicine, Aurora, and project manager with the Adult and Child Center for Outcomes Research and Delivery Science at the University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora. “Knowing that family physicians felt they could most use help with primary prevention services can generate development and testing of a variety of different prevention approaches, including ones tailored for different types of practice settings.”
The 19-question survey addressed several areas, including perceived need for improvement across various preventive services and the service with which clinicians would most like assistance, along with physician and practice characteristics.
The researchers selected 11 USPSTF preventive services that were graded A or B, and added items on screening for peripheral vascular disease and addressing cancer survivorship. The authors then assigned the activities into four general categories: primary prevention, cancer screening, non-cancer screening and cancer survivorship.
Story Highlights
More than 8,300 clinicians were invited to take the survey; a total of 326 eligible surveys were analyzed.
Surprising Findings
Clinicians felt the greatest need for improvement with primary prevention activities. Composite ratings for need of improvement in this category were significantly higher than either cancer or non-cancer composites.
Of the five primary prevention activities surveyed, clinicians reported the greatest need for improvement with assessment and counseling for nutrition and dietary behaviors, physical activity and tobacco use.
Among screening activities, perceived need for improvement was highest with screening for colorectal cancer, lung cancer and breast cancer, and lowest for peripheral artery disease and lipid disorders.
Clinicians also were asked to select one item among the primary prevention and cancer screening activities that they would like the most help implementing. Nutrition and dietary counseling was selected most frequently, followed by lung cancer screening and physical activity assessment and counseling.
The survey authors were surprised by the high perceived need for improvement with primary prevention counseling compared with screening and other services, and offered various explanations. They suggested, for example, that while clinicians recognize the importance of this service, there is little to no reimbursement for it; as such, the authors speculated that clinicians “see greater need for assistance if they are going to be able to address these issues than for care issues for which they are held accountable and receive reimbursement.”
The authors also were surprised at the lack of differences in rated need for improvement across preventive service activities between clinicians in rural and non-rural settings, considering that rural clinicians often have fewer resources and face greater challenges in addressing their patients’ social determinants of health.
“There may be other factors that moderated our results that were not assessed, or it may be that rural practitioners are used to ‘doing it on their own,’ and despite having generally fewer resources, do not perceive any greater need for assistance,” the authors said.
The researchers called for additional research to reproduce their findings using different settings, populations and types of preventive service activities. They also called for studies to account for factors such as practice type and size, as well as health equity issues that could influence findings.
FPs Sought for Further Research
While many of the survey participants perceived a need for improvement with regard to primary prevention services, Brtnikova said that it’s too soon to determine exactly what types of resources or assistance would be most beneficial for family physicians.
“We need to first hear from different FPs what they feel they need,” Brtnikova said.
“Our overall results on ratings of feasibility and impact of different implementation strategies indicated that most FPs selected adapting an evidence-based intervention (or guideline) to their practice,” she continued. “We also think that FPs can benefit from access to decision-making and costing tools, like the ones developed under the Colorado Implementation Science Center for Cancer Control. We would like to hear if practices could use assistance in consistently assessing and acting on social determinants of health issues. Lastly, more practice-research partnerships to identify the most effective implementation strategies for specific contexts should help make preventive medicine more tangible.”
Brtnikova added that planning is already underway for future research.
“The ultimate direction will depend on the research partners involved and results of our current shared decision-making research,” she said. “We also have a proposal under review to implement a health risk appraisal and feedback web tool that helps inform patients and practices about nine different behavior change and mental health risks and individual health risks that helps patients set goals for areas they prioritize. We would welcome participation in it.”
Family physicians interested in participating are invited to contact Elise Robertson, M.A., research project manager in the AAFP’s Practice-Based Research, Innovation and Evaluation Division.