Correlates of clinical preventive practices among internal medicine residents

BACKGROUND: Healthy People: 2010 calls for improvement in the delivery of clinical preventive services. Physicians value preventive services, yet their rates of prevention consistently fall below recommendations. This study examines the relationship between personal characteristics of internal medicine residents and their clinical prevention practices in an outpatient setting. METHODS: Participants were 56 of 80 physicians (70%) in an internal medicine residency program in New Jersey. Personal characteristics (i.e., demographics, specialty orientation, attitudes toward prevention, and personal health behaviors) of the residents were collected via a self-administered survey. A 12-month retrospective chart review of 184 new doctor-patient encounters was performed to determine rates of clinical preventive services. RESULTS: Clinical preventive services were performed at varying rates, and differential practices specific to the patient's gender and/or age were detected for several services. Multiple regression revealed four significant predictors of overall prevention practice: clinic site, international medical graduates, generalist orientation, and self perceived health status (R(2) = 0.32). Predictors of health promotion counseling were clinic site, international medical graduates, and generalist orientation (R(2) = 0.30). CONCLUSIONS: While personal characteristics such as self-rated health and generalist orientation were associated with preventive practices, factors related to the office environment were also associated with increased delivery of clinical preventive services. Prevention-oriented office systems, such as "Put Prevention Into Practice," should be worthwhile considerations to increase delivery of preventive services.