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Am Fam Physician. 2000;62(9):1968

See editorial on page 1984.

Having a usual source of care enhances achieving clinical prevention goals for children and adults. There is room for improvement, and differences between the practices of internists and family physicians suggest that slightly longer visits and having health insurance might contribute to achieving proven prevention strategies.

The 1996 Medical Expenditure Panel Survey (MEPS) sponsored by the Agency for Healthcare Quality and Research (AHQR; formerly the Agency for Health Care Policy and Research) can be generalized to the United States. In this survey, respondents most often identified an individual generalist physician, typically a family physician, pediatrician or internist as their usual source of care.
Having any usual source of care, either a facility or an individual provider, was uniformly associated with children less than six years of age obtaining their immunizations and adults receiving preventive services during the past year:
Have usual source (%)No usual source (%)
Children:
Diphtheria-pertussis-tetanus9790
Polio9685
Measles-mumps-rubella9282
Hepatitis B8073
Adults:
Blood pressure check8356
Cholesterol check5123
Flu shot3013
General examination5228
Men: prostate examination3610
Women: Papanicolaou smear6047
Women: mammogram5129
Women: Any breast examination6546
Adults with a general internist as their usual source of care received more preventive care in 1996 than those with a family physician. This was the case for men and women:
General internist (%)Family physician (%)
Blood pressure check9083
Cholesterol check6651
Flu shot4330
General examination6250
Men: prostate examination5235
Women: Papanicolaou smear6057
Women: mammogram6048
Women: Any breast examination7063
The reasons for these differences are uncertain. Provision of preventive care may be related to time spent with patients. According to the 1996 National Ambulatory Medical Care Survey (NAMCS), patient visits with general internists averaged 15.9 minutes, while visits with family physicians were 14.1 minutes, 13 percent shorter. Also, preventive care may be related to patients' insurance status. According to the 1996 MEPS, only 5.5 percent of adult patients for whom general internists were the usual source of care were uninsured, but 12.2 percent of patients of family physicians lacked insurance. This suggests that reducing noninsurance rates and adding a minute or two to visits might help close the gap between ideal targets for clinical preventive services and what is currently being done.

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