Promoting prevention services in primary care: a controlled trial

We used a two-group hybrid, multiple baseline and reversal design to assess the efficacy of a prompt--an in-chart checklist--for increasing screening, counseling, and referral for 11 risk behaviors. Chart reviews for randomly selected patients of each provider showed very low baseline levels of these services for routine visits (0.2% to 3.8%). But significant increases occurred in discussion and prescription of change (although not in referrals) during intervention. Patient visits for routine gynecologic care and birth control showed higher baseline levels (10.8% to 21.0%) and also had a significant increase in discussion of risk behaviors. However, no significant change occurred in prescription or referral for these patients. Follow-up interviews of providers supported the reliability of the results and raised issues about attitudes toward primary care health promotion. Provider variability in response to the intervention suggests that more tailored interventions might increase provision of comprehensive health promotion services by a broad spectrum of primary care providers.