Bross M H, Hartwig L C, Herring J
University of Mississippi Medical Center, Jackson 39216.
J Health Soc Policy. 1993;5(1):59-69. doi: 10.1300/J045v05n01_06.
Family and general practice physicians deliver comprehensive health care over time and are well suited to promote health and prevent disease. Prior studies of preventive medicine routines have tended to address a limited number of the recommended practices. The purpose of this study was to: (1) estimate the level of primary care physician compliance with the wide range of physician recommendations in Healthy People 2000: National Health Promotion and Disease Prevention Objectives for the Year 2000 and (2) identify practice characteristics associated with performance of preventive health care. Full-time family and general practice physicians, located in rural Mississippi towns of 5,000 to 10,000, were selected for the study. Of 94 eligible physicians, 81 were surveyed (73 surveys completed on site and 8 surveys returned by mail). The physicians treated a mean of 35 patients per day, with a disproportionate number of elderly patients. Limited physician time was ranked by physicians as the greatest obstacle to preventive medicine. Physicians were found to practice more preventive medicine in the adult and elderly patients than in the children and adolescents. Cancer, cardiovascular, and infectious disease risks were well addressed, with little attention directed toward occupational and environmental (e.g., lead, firearm, automobile) risks. Two practice characteristics were consistently associated with higher preventive medicine scores: an assigned preventive medicine staff member and preventive medicine flow charts. This information, obtained in a medically underserved area, may be used to assist physicians in meeting the Healthy People 2000 objectives. More research is needed to identify effective approaches for health risks that were not well addressed in physician offices.
家庭医生和全科医生长期提供全面的医疗保健服务，非常适合促进健康和预防疾病。先前关于预防医学常规的研究往往只涉及有限数量的推荐做法。本研究的目的是：（1）估计基层医疗医生对《2000年健康人群：2000年国家健康促进和疾病预防目标》中广泛的医生建议的遵守程度；（2）确定与预防性医疗保健表现相关的执业特征。研究选取了位于密西西比州农村地区、人口在5000至10000之间的全职家庭医生和全科医生。在94名符合条件的医生中，81名接受了调查（73份现场完成，8份通过邮件返回）。这些医生平均每天诊治35名患者，老年患者的比例过高。医生们将有限的时间列为预防医学的最大障碍。结果发现，医生在成人和老年患者中比在儿童和青少年中实施更多的预防医学措施。癌症、心血管疾病和传染病风险得到了较好的处理，但对职业和环境（如铅、枪支、汽车）风险关注较少。有两个执业特征始终与较高的预防医学得分相关：指定的预防医学工作人员和预防医学流程图。在医疗服务不足地区获得的这些信息，可用于帮助医生实现《2000年健康人群》的目标。需要更多的研究来确定针对医生办公室未充分处理的健康风险的有效方法。
