Physician performance of preventive care for women

The purpose of this study was to examine whether academic primary care physicians recommended appropriate preventive care to their female patients, whether recommendations differed for different types of physicians, and how often these recommendations led to completion of the preventive service.

A retrospective chart review was conducted in the family medicine and internal medicine outpatient practices at the Medical Center of Delaware (MCD). A total of 324 women ages 40 and over were selected from the patient panels of nine faculty and 14 residents. Physician recommendation of PAP smears, mammograms, breast exams, and influenza immunizations were measured against the guidelines of the U.S. Preventive Service Task Force. Specifically examined was whether rates of recommendation differed by specialty, gender and faculty/resident status of the physician. Also measured was completion of each preventive service and whether rates of completion differed from rates of physician recommendation.

Physicians recommended appropriate PAPs in 72 percent of patients, mammograms in 83 percent of patients, breast exams in 46 percent of patients and influenza immunizations in 30 percent of patients. Family physicians were more likely to recommend PAP smears (odds ratio 5.53, 95 percent confidence interval 2.26-12.98), but not more likely to recommend other services; female physicians were more likely to recommend breast exams (odds ratio 3.48, 95 percent confidence interval 2.05-5.89), but not other services. There were no significant differences between faculty and residents. Preventive services were completed in 48 percent of patients for PAPs, 68 percent for mammograms, 42 percent for breast exams, and 27 percent for flu shots.

In academic primary care practices at MCD, physicians perform well in recommending PAPs and mammograms, but not in recommending breast exams or influenza immunizations. There were few differences in performance among different types of physicians. Because many women did not follow through with their physicians' recommendations for preventive care, physician performance is more accurately measured according to their recommendations rather than completion of services. Efforts to improve preventive care in women should differ depending on whether the problem lies in physician performance or patient behavior.