Preventive care and barriers to effective prevention. How do family physicians see it?

OBJECTIVES: To assess how adequately family physicians think they are delivering preventive care and to examine barriers to providing preventive care. DESIGN: Cross-sectional survey. SETTING: Primary care medical practices in south-central Ontario. PARTICIPANTS: Four hundred eighty family physicians and general practitioners who graduated from medical school between 1972 and 1988. MAIN OUTCOME MEASURES: Satisfactory preventive care delivery versus self-assessed coverage of patients for 15 preventive maneuvers. Perceived reasons for lack of success in providing recommended preventive care. RESULTS: For 10 of the 15 maneuvers, the proportion of physicians who regarded 90% or higher as satisfactory coverage was twice as great as the proportion who thought they provided that level of coverage. For 11 of the 15 maneuvers, most respondents reported coverage lower than the level they regarded as satisfactory. For six maneuvers, more than two thirds thought they provided less than satisfactory coverage. More than two thirds of respondents suggested these barriers to providing recommended preventive care: patient is healthy and does not visit; patient refuses, is not interested, or does not comply; no effective systems to remind patients to come in for preventive care; and priority given to presenting problem. CONCLUSION: Many family physicians and general practitioners in south-central Ontario provide preventive care to their patients at lower levels than they consider satisfactory. They identified barriers to providing preventive services successfully; these barriers suggest approaches for improving care.