Skip to main content
NCBI home page
Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2010 Jan 1;101(1):65–71. [Article in French] doi: 10.1007/BF03405565

Pratiques cliniques préventives et besoins pour leur intégration chez des médecins d’un centre hospitalier universitaire à Montréal

Julio C Soto 117,✉, Maria L Chauvet 117, Stéphane Groulx 217, Sylvie Provost 317
PMCID: PMC6973848  PMID: 20364542

Abstract

Objectives

Present a picture of physicians’ preventive clinical practices (PCP) at a university medical centre, and identify the obstacles that hinder their implementation.

Method

Self-administered questionnaire survey addressed to 367 general practitioners and specialists working at the Centre hospitalier de l’Université de Montréal (CHUM) in 2006.

Results

Respondents claim to be recommending PCP (often or very often) in approximately 60-82% of cases. Women physicians report a larger integration for screening and vaccination (p<0.05). General physicians claim to apply or recommend PCP more frequently than specialists (p<0.05), except for anti-tobacco counseling. Lack of time (82%) and deficiencies in continuity of treatment (75%) are considered by the majority of respondents as major obstacles to the realization of PCP. Most participants (99%) consider delivering preventive services to be part of their role and 98% claim to be motivated to integrate PCP into their practice. However, almost half of physicians do not apply preventive recommendations to their own life and at least two thirds of them doubt the efficacy of counseling.

Conclusion

Despite observed encouraging results, actions must be taken to improve the integration of PCP to general and specialized health care and to bring physicians around to adopting healthy lifestyle habits themselves.

Keywords: Clinical prevention, preventive clinical practices, preventive clinical practice guidelines, preventive practice obstacles

Footnotes

Remerciements: Les auteurs remercient les médecins ayant participé à l’enquête, les consultants et les collaborateurs qui ont participé au pré-test ou qui ont partagé leurs opinions lors de la conceptualisation de l’étude et l’élaboration du rapport final. Cette étude a été réalisée grâce à l’appui institutionnel de la Direction générale du CHUM et l’appui logistique de la Direction de la gestion et de la qualité-performance et de la Direction des services professionnels du CHUM.

Conflit d'intérêts: Aucun déclaré.

Références

  • 1.Silverstein MD, Ogola G, Mercer Q, Fong J, Devol E, Couch CE, Ballard DJ. Impact of clinical preventive services in the ambulatory setting. Proc Bayl Univ Med Cent. 2008;21(3):227–35. doi: 10.1080/08998280.2008.11928400. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Yarnall KSH, Pollak KI, Østbye T, Krause KM, Michener JL. Am J Public Health. 2003. Primary care: Is there enough time for prevention? [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Lopez-de-Munain J, Torcal J, Lopez V, Garay J. Prevention in routine general practice: Activity patterns and potential promoting factors. Prev Med. 2001;32:13–22. doi: 10.1006/pmed.2000.0777. [DOI] [PubMed] [Google Scholar]
  • 4.Hudon E, Beaulieu MD, Roberge D. Integration of the recommendations of the Canadian Task Force on Preventive Health Care. Obstacles perceived by a group of family physicians. Fam Pract. 2004;21:1. doi: 10.1093/fampra/cmh104. [DOI] [PubMed] [Google Scholar]
  • 5.Provost S, Drouin M. Pratiques cliniques préventives de médecins omniprati-ciens. Portrait de la situation dans les Laurentides. Québec: Agence de développement de réseaux locaux de services de santé et de services sociaux, Direction de santé publique des Laurentides. 2005. [Google Scholar]
  • 6.Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PAC, Rubin HR. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–65. doi: 10.1001/jama.282.15.1458. [DOI] [PubMed] [Google Scholar]
  • 7.McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45. doi: 10.1056/NEJMsa022615. [DOI] [PubMed] [Google Scholar]
  • 8.Hutchison B, Woodward CA, Norman GR, Abelson J, Brown JA. Provision of preventive care to unannounced standardized patients. CMAJ. 1998;158(2):185–93. [PMC free article] [PubMed] [Google Scholar]
  • 9.Smith HE, Herbert CP. Preventive practice among primary care physicians in British Columbia: Relation to recommendations of the Canadian Task Force on the Periodic Health Examination. CMAJ. 1993;149(12):1795–800. [PMC free article] [PubMed] [Google Scholar]
  • 10.Sauvageau C, Groulx S, Pelletier A, Ouakki M, Dubé E. Les médecins discutent-ils des habitudes de vie avec leurs patients? Can J Public Health. 2008;99(1):31–35. doi: 10.1007/BF03403737. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Cornuz J, Ghali WA, Di Carlantonio D, Pecoud A, Paccaud F. Physicians’ attitudes towards prevention: Importance of intervention-specific barriers and physicians’ health habits. Fam Pract. 2000;17(6):535–40. doi: 10.1093/fampra/17.6.535. [DOI] [PubMed] [Google Scholar]
  • 12.Hosner DW, Lemeshow S. Applied Logistic Regression. New York, NY: John Wiley & Sons; 2000. [Google Scholar]
  • 13.Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50(10):1129–36. doi: 10.1016/S0895-4356(97)00126-1. [DOI] [PubMed] [Google Scholar]
  • 14.Maheux B, Dufort F, Lambert J, Berthiaume B. Do female general practitioners have a distinctive type of medical practice? CMAJ. 1988;139(8):737–40. [PMC free article] [PubMed] [Google Scholar]
  • 15.Montaño DE, Phillips WR. 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;85(6):795–800. doi: 10.2105/AJPH.85.6.795. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Stange KC, Zyzanski SJ, Jaen CR, Callahane J, Kelly RB, Gillander W e coll. Illuminating the “black box”: A description of 4454 patient visits to 138 family physicians. J Fam Pract. 1998;46:377–89. [PubMed] [Google Scholar]
  • 17.Dresselhaus TR, Peabody JW, Lee M, Wang MM, Luck J. Measuring compliance with preventive care guidelines: Standardized patients, clinical vignettes, and the medical record. J Gen Intern Med. 2000;15(11):782–88. doi: 10.1046/j.1525-1497.2000.91007.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Ewing GB, Selassie AW, Lopez CH, McCutcheon EP, Ewing GB, Selassie AW, Lopez CH. Self-report of delivery of clinical preventive services by U.S. physicians. Comparing specialty, gender, age, setting of practice, and area of practice. Am J Prev Med. 1999;17(1):62–72. doi: 10.1016/S0749-3797(99)00032-X. [DOI] [PubMed] [Google Scholar]
  • 19.Frank E, Rothenberg R, Lewis C, Belodoff BF. Correlates of physicians’ prevention-related practices: Findings from the Women Physicians’ Health Study. Arch Fam Med. 2000;9:359–67. doi: 10.1001/archfami.9.4.359. [DOI] [PubMed] [Google Scholar]
  • 20.Henderson JT, Weisman CS. Physician gender effects on preventive screening and counseling: An analysis of male and female patients’ health care experiences. Med Care. 2001;39(12):1281–92. doi: 10.1097/00005650-200112000-00004. [DOI] [PubMed] [Google Scholar]
  • 21.Lurie N, Margolis KL, Mcgovern PG, Mink PJ, Slater JS. Why do patients of female physicians have higher rates of breast and cervical cancer screening? J Gen Intern Med. 1997;12(1):34–43. doi: 10.1007/s11606-006-0005-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Bertakis KD, Franks P, Azari R. Effects of physician gender on patient satisfaction. J Am Med Womens Assoc. 2003;58(2):69–75. [PubMed] [Google Scholar]
  • 23.Flocke SA, Gilchrist V. Physician and patient gender concordance and the delivery of comprehensive clinical preventive services. Med Care. 2005;43:486–92. doi: 10.1097/01.mlr.0000160418.72625.1c. [DOI] [PubMed] [Google Scholar]
  • 24.O’Loughlin J, Makni H, Tremblay M, Karp I. Gender differences among general practitioners in smoking cessation counseling practices. Prev Med. 2007;45:208–14. doi: 10.1016/j.ypmed.2007.06.005. [DOI] [PubMed] [Google Scholar]
  • 25.Ayres CG, Griffith HM. Consensus guidelines: Improving the delivery of clinical preventive services. Health Care Manage Rev. 2008;33(4):300–7. doi: 10.1097/01.HCM.0000318767.36901.0b. [DOI] [PubMed] [Google Scholar]
  • 26.Frank JR, editor. Le Cadre de compétences CanMEDS 2005 pour les médecins. L’excellence des normes, des médecins et des soins. Ottawa, ON: Le Collège royal des médecins et chirurgiens du Canada; 2005. [Google Scholar]
  • 27.Russell GM. Is prevention unbalancing general practice? MJA. 2005;183(2):104–5. doi: 10.5694/j.1326-5377.2005.tb06942.x. [DOI] [PubMed] [Google Scholar]
  • 28.Thind A, Feightner J, Stewart M, Thorpe C, Burt A. Who delivers preventive care as recommended? Analysis of physician and practice characteristics. Can Fam Phys. 2008;54(11):1574–75. [PMC free article] [PubMed] [Google Scholar]
  • 29.Yarnall KS, Østbye T, Krause KM, Pollak KI, Gradison M, Michener JL. Prev Chronic Dis. 2009. Family physicians as team leaders: “Time” to share the care. [PMC free article] [PubMed] [Google Scholar]
  • 30.Provost MH, Cardinal L, Moreault L, Pineau R. Description, impact et conditions d’efficacité des stratégies visant l’intégration de la prévention dans les pratiques cliniques: revue de la littérature: l’intégration de pratiques cliniques préventives. Québec: MSSS; 2007. [Google Scholar]

Articles from Canadian Journal of Public Health = Revue Canadienne de Santé Publique are provided here courtesy of Springer

RESOURCES