Improving physician compliance with a health maintenance protocol.

A two-year prospective study was conducted to determine whether specific educational, organizational, and behavior reinforcing interventions could improve physician performance of selected health maintenance procedures in the private practice setting. The procedures studied included history of tobacco use, blood pressure determination, history of alcohol use, fecal occult blood testing for colon cancer, Pap smears, and physician breast examinations. Overall compliance with these procedures improved from 58 percent to 72 percent. There were marked differences in compliance among the procedures, ranging from 99 percent of patients having their blood pressure recorded to 51 percent having a fecal occult blood screening for colon cancer. Compliance with use of a screening flow sheet was much less than compliance with specific procedures. The screening flow sheet was completed on only 29 percent of patients' charts.