Abstract
OBJECTIVE: To assess to what extent family physicians perform the maneuvers for elderly patients recommended by the Canadian Task Force on Preventive Health Care (CTF), and to compare physicians' performance among patients who had structured periodic health examinations with performance among those who did not. DESIGN: Retrospective chart audit. SETTING: Family practice unit in a secondary care, university-affiliated hospital in Toronto, Ont. PARTICIPANTS: Records of 136 community-dwelling patients aged 70 and older. Of 340 randomly selected charts, 108 were excluded and 51 were inaccessible; 100 had had PHEs, and a random sample of 36 who had attended the clinic three or more times was chosen from the remaining 81 [corrected]. MAIN OUTCOME MEASURES: Proportion of patients who received the recommended screening maneuvers. RESULTS: Charts were audited for 100 patients who had structured periodic health examinations and 36 who did not but who attended the clinic three or more times during an 18-month period. Screening rates among patients who had structured examinations ranged from 28% of patients screened for hearing impairment to 100% screened for hypertension. Patients who did not have structured examinations were significantly less likely to receive screening maneuvers. CONCLUSIONS: Screening rates were below desirable levels in patients older than 70 years. Screening during structured health examinations seems to be more effective than opportunistic screening for patients 70 and older.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aubin M., Vézina L., Fortin J. P., Bernard P. M. Effectiveness of a program to improve hypertension screening in primary care. CMAJ. 1994 Feb 15;150(4):509–515. [PMC free article] [PubMed] [Google Scholar]
- Battista R. N. Adult cancer prevention in primary care: patterns of practice in Québec. Am J Public Health. 1983 Sep;73(9):1036–1039. doi: 10.2105/ajph.73.9.1036. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Battista R. N., Palmer C. S., Marchand B. M., Spitzer W. O. Patterns of preventive practice in New Brunswick. Can Med Assoc J. 1985 May 1;132(9):1013–1015. [PMC free article] [PubMed] [Google Scholar]
- Brull R., Ghali W. A., Quan H. Missed opportunities for prevention in general internal medicine. CMAJ. 1999 Apr 20;160(8):1137–1140. [PMC free article] [PubMed] [Google Scholar]
- Caulfield P. A., Frank J. W., McMurray L., Henderson M., Hutchison B. A pilot home-based geriatric health screening project in primary care. Clin Geriatr Med. 1986 Feb;2(1):85–97. [PubMed] [Google Scholar]
- Cheney C., Ramsdell J. W. Effect of medical records' checklists on implementation of periodic health measures. Am J Med. 1987 Jul;83(1):129–136. doi: 10.1016/0002-9343(87)90507-9. [DOI] [PubMed] [Google Scholar]
- Chu F. Z., Day R. G. Smoking recognition by family physicians. J Fam Pract. 1981 Apr;12(4):657–660. [PubMed] [Google Scholar]
- Cowan J. A., Heckerling P. S., Parker J. B. Effect of a fact sheet reminder on performance of the periodic health examination: a randomized controlled trial. Am J Prev Med. 1992 Mar-Apr;8(2):104–109. [PubMed] [Google Scholar]
- Davis D. A., Thomson M. A., Oxman A. D., Haynes R. B. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700–705. doi: 10.1001/jama.274.9.700. [DOI] [PubMed] [Google Scholar]
- Denen M. E., Hennessey J. V., Markert R. J. Outpatient evaluation of obesity in adults and children: a review of the performance of internal medicine/pediatrics residents. J Gen Intern Med. 1993 May;8(5):268–270. doi: 10.1007/BF02600096. [DOI] [PubMed] [Google Scholar]
- Ewing J. A. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905–1907. doi: 10.1001/jama.252.14.1905. [DOI] [PubMed] [Google Scholar]
- Flocke S. A., Stange K. C., Goodwin M. A. Patient and visit characteristics associated with opportunistic preventive services delivery. J Fam Pract. 1998 Sep;47(3):202–208. [PubMed] [Google Scholar]
- Hay W. I., Browne G., Roberts J., Jamieson E. Prospective care of elderly patients in family practice. Part 3: Prevalence of unrecognized treatable health concerns. Can Fam Physician. 1995 Oct;41:1695-704, 1707-10. [PMC free article] [PubMed] [Google Scholar]
- Hindmarsh J. J., Estes E. H., Jr Falls in older persons. Causes and interventions. Arch Intern Med. 1989 Oct;149(10):2217–2222. [PubMed] [Google Scholar]
- Hutchison B., Woodward C. A., Norman G. R., Abelson J., Brown J. A. Provision of preventive care to unannounced standardized patients. CMAJ. 1998 Jan 27;158(2):185–193. [PMC free article] [PubMed] [Google Scholar]
- Katz A. Canadian Task Force on the Periodic Health Examination. Annual checkup revisited. Can Fam Physician. 1996 Sep;42:1637-8, 1648-50. [PMC free article] [PubMed] [Google Scholar]
- Lachs M. S., Feinstein A. R., Cooney L. M., Jr, Drickamer M. A., Marottoli R. A., Pannill F. C., Tinetti M. E. A simple procedure for general screening for functional disability in elderly patients. Ann Intern Med. 1990 May 1;112(9):699–706. doi: 10.7326/0003-4819-112-9-699. [DOI] [PubMed] [Google Scholar]
- Luckmann R., Melville S. K. Periodic health evaluation of adults: a survey of family physicians. J Fam Pract. 1995 Jun;40(6):547–554. [PubMed] [Google Scholar]
- Montaño D. E., Phillips W. R. Cancer screening by primary care physicians: a comparison of rates obtained from physician self-report, patient survey, and chart audit. Am J Public Health. 1995 Jun;85(6):795–800. doi: 10.2105/ajph.85.6.795. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moore A. A., Siu A. l., Partridge J. M., Hays R. D., Adams J. A randomized trial of office-based screening for common problems in older persons. Am J Med. 1997 Apr;102(4):371–378. doi: 10.1016/s0002-9343(97)00089-2. [DOI] [PubMed] [Google Scholar]
- Morris P. D., Morris E. R. Family practice residents' compliance with preventive medicine recommendations. Am J Prev Med. 1988 May-Jun;4(3):161–165. [PubMed] [Google Scholar]
- Norman G. R., Neufeld V. R., Walsh A., Woodward C. A., McConvey G. A. Measuring physicians' performances by using simulated patients. J Med Educ. 1985 Dec;60(12):925–934. doi: 10.1097/00001888-198512000-00004. [DOI] [PubMed] [Google Scholar]
- Patterson C., Chambers L. W. Preventive health care. Lancet. 1995 Jun 24;345(8965):1611–1615. doi: 10.1016/s0140-6736(95)90119-1. [DOI] [PubMed] [Google Scholar]
- Rodney W. M., Chopivsky P., Quan M. Adult immunization: the medical record design as a facilitator for physician compliance. J Med Educ. 1983 Jul;58(7):576–580. [PubMed] [Google Scholar]
- Romm F. J., Fletcher S. W., Hulka B. S. The periodic health examination: comparison of recommendations and internists' performance. South Med J. 1981 Mar;74(3):265–271. doi: 10.1097/00007611-198103000-00004. [DOI] [PubMed] [Google Scholar]
- Rosser W. W., McDowell I., Newell C. Use of reminders for preventive procedures in family medicine. CMAJ. 1991 Oct 1;145(7):807–814. [PMC free article] [PubMed] [Google Scholar]
- Rubenstein L. Z., Robbins A. S., Josephson K. R., Schulman B. L., Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Ann Intern Med. 1990 Aug 15;113(4):308–316. doi: 10.7326/0003-4819-113-4-308. [DOI] [PubMed] [Google Scholar]
- Schwartz J. S., Lewis C. E., Clancy C., Kinosian M. S., Radany M. H., Koplan J. P. Internists' practices in health promotion and disease prevention. A survey. Ann Intern Med. 1991 Jan 1;114(1):46–53. doi: 10.7326/0003-4819-114-1-46. [DOI] [PubMed] [Google Scholar]
- Stange K. C., Flocke S. A., Goodwin M. A. Opportunistic preventive services delivery. Are time limitations and patient satisfaction barriers? J Fam Pract. 1998 May;46(5):419–424. [PubMed] [Google Scholar]
- Stange K. C., Zyzanski S. J., Smith T. F., Kelly R., Langa D. M., Flocke S. A., Jaén C. R. How valid are medical records and patient questionnaires for physician profiling and health services research? A comparison with direct observation of patients visits. Med Care. 1998 Jun;36(6):851–867. doi: 10.1097/00005650-199806000-00009. [DOI] [PubMed] [Google Scholar]
- Tinetti M. E., Speechley M., Ginter S. F. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988 Dec 29;319(26):1701–1707. doi: 10.1056/NEJM198812293192604. [DOI] [PubMed] [Google Scholar]