Assessment of Physician Priorities in Delivery of Preventive Care

• Published in: JAMA network open 2020-07, Vol.3 (7), p.e2011677-e2011677
• Main Authors: Zhang, Jessica J, Rothberg, Michael B, Misra-Hebert, Anita D, Gupta, Niyati M, Taksler, Glen B
• Format: Article
• Language: English
• Subjects: Adult; Breast cancer; Clinical Competence - standards; Colorectal cancer; Comorbidity; Delivery of Health Care - methods; Delivery of Health Care - standards; Delivery of Health Care - trends; Family medical history; Female; Health Policy; Health Priorities - standards; Health Priorities - trends; Humans; Hypertension; Life expectancy; Male; Mathematical models; Medical screening; Middle Aged; Online Only; Original Investigation; Patients; Physicians; Physicians - psychology; Physicians - standards; Physicians - statistics & numerical data; Physicians, Primary Care - standards; Physicians, Primary Care - trends; Preventive medicine; Preventive Medicine - methods; Preventive Medicine - standards; Preventive Medicine - trends; Primary care; Smoking cessation; Time Factors; Weight control
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2020.11677

Primary care physicians have limited time to discuss preventive care, but it is unknown how they prioritize recommended services. To understand primary care physicians' prioritization of preventive services. This online survey was administered to primary care physicians in a large health care system from March 17 to May 12, 2017. Physicians were asked whether they prioritize preventive services and which factors contribute to their choice (5-point Likert scale). Results were analyzed from July 8, 2017, to September 19, 2019. A 2 × 2 factorial design of 2 hypothetical patients: (1) a 50-year-old white woman with hypertension, type 2 diabetes, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of breast cancer; and (2) a 45-year-old black man with hypertension, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of colorectal cancer. Two visit lengths (40 minutes vs 20 minutes) were given. Each patient was eligible for at least 11 preventive services. Physicians rated their likelihood of discussing each service during the visit and reported their top 3 priorities for patients 1 and 2. Physician choices were compared with the preventive services most likely to improve life expectancy, using a previously published mathematical model. Of 241 physicians, 137 responded (57%), of whom 74 (54%) were female and 85 (62%) were younger than 50 years. Physicians agreed they prioritized preventive services (mean score, 4.27 [95% CI, 4.12-4.42] of 5.00), mostly by ability to improve quality (4.56 [95% CI, 4.44-4.68] of 5.00) or length (4.53 [95% CI, 4.40-4.66] of 5.00) of life. Physicians reported more prioritization in the 20- vs 40-minute visit, indicating that they were likely to discuss fewer services during the shorter visit (median, 5 [interquartile range {IQR}, 3-8] vs 11 [IQR, 9-13] preventive services for patient 1, and 4 [IQR, 3-6] vs 9 [IQR, 8-11] for patient 2). Physicians reported similar top 3 priorities for both patients: smoking cessation, hypertension control, and glycemic control for patient 1 and smoking cessation, hypertension control, and colorectal cancer screening for patient 2. Physicians' top 3 priorities did not usually include diet and exercise or weight loss (ranked in their top 3 recommendations for either patient by only 48 physicians [35%]), although these were among the 3 preventive services most likely to improve life expectancy based on the mathematical model. In this survey study