Screening guidelines in a family medicine program: a five-year experience

An audit of charts of 112 adult patients at the University of Rochester Family Medicine Program was conducted to determine the effect of screening guidelines introduced into the practice in 1975. Beyond the initial educational effort when the guidelines were introduced and a verbal explanation of the guidelines printed in each patient record given to new providers as they entered the program, no continuous encouragement was offered. Over the next five years, provider compliance fell short of the guideline recommendations for all 10 screening tests. Depending on the test, 10 to 100 percent of patients received no screening over that period. Tests performed by nursing personnel were completed more frequently than those performed by physicians (P=0.05). Frequency of screening by physicians correlated with the frequency of complete physical examination (P less than 0.0001) and sex (P less than 0.02), and screening by nurses correlated with complete physical examination frequency (P less than 0.0001), visit rate (P less than 0.0001), and patient age (P less than 0.0001). Awareness of screening recommendations was insufficient to result in provider compliance with them. Strategies for improving screening compliance are discussed.