Abstract
Background: Little is known about the content of routine health maintenance exams (HMEs) delivered by primary care physicians (PCP) in today’s busy primary care practices. We describe the frequency of patient-physician cancer screening discussions amidst the competing demands of other preventive services during routine HMEs to understand HME content in the real world of primary care.
Methods: We use direct observation of PCP-patient interactions during HMEs to examine discussions around breast, colorectal (CRC), cervical, lung and prostate cancer screening and other lifestyle topics. Visits represent the first 103 visits completed in an NIH-funded study using in-office observations, audio-recordings and patient surveys to study CRC screening recommendations. Physician participants (n=34) are general internists or family physicians practicing in a large integrated delivery system in southeast Michigan with patient-specific electronic medical record prompts for evidence-based cancer screening. Patient participants were aged 50–80 years who scheduled an HME with a participating physician and were due for CRC screening (i.e., no colonoscopy or barium enema within 10 years, flexible sigmoidoscopy within 5 years, or fecal occult blood testing (FOBT) within 12 months).
Results: CRC screening was mentioned in 96% of observed HMEs. Among visits by women (n=74), 85% mentioned breast and 51% cervical cancer screening. Among visits by men (n=29), 72% mentioned prostate cancer screening. Lung cancer screening was mentioned in 15% of visits. The physician initiated these discussions more than 80% of the time, with the exception of lung cancer screening (53%). Colonoscopy was overwhelmingly the procedure recommended for CRC screening (82%), followed by FOBT (37%) and others (4%). Other topics frequently discussed were exercise (88%), cholesterol (81%), smoking (68%), weight (68%), blood pressure (65%), and diet (65%). While these discussions were usually initiated by physicians, patients were relatively more likely to initiate discussions around weight (41%) and diet (35%).
Conclusions: In this study of patients due for CRC screening, discussions did occur and specific recommendations frequently were made for CRC screening. Other cancer screening and preventive issues were discussed, but less frequently. PCPs are uniquely positioned to impact the delivery of these preventive measures and seem to be successfully striving to meet guidelines, particularly those for CRC screening.
- Received September 11, 2008.
