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Improving Preventive Health Care in a Medical Resident Practice
Lavoisier J. Cardozo, MD;
Joel Steinberg, MD;
Mary Beth Lepczyk, RN, MSN, CS;
Lisa Binns-Emerick, RN, MSN, CS;
Yvonne Cardozo;
Anil N. F. Aranha, MS, ABD
Arch Intern Med. 1998;158:261-264.
Background The ambulatory care resident practice is an opportunity to enhance the skills, knowledge, and attitudes for effective provision of preventive health services (PHS).
Objective To determine whether a required intervention at a university medical resident practice would lead to improved performance of 6 secondary PHS.
Methods A sequentially randomized chart analysis was performed at 2 clinics, a collaborative nurse practitioner practice (NP) and a resident practice (RP) to determine performance rate of secondary PHS (pelvic, prostate, and breast examinations, stool guaiac testing, mammography, and prostate-specific antigen determination). A significantly lower (36.9%) PHS performance rate was noted in the RP compared with 84.5% in NP for all 6 secondary PHS studied. An intervention was implemented in the RP: following every resident-patient clinic encounter a discussion and documentation of the patient's PHS status was required as part of the assessment and plans of management. At the end of 1 year the effect of this intervention on performance rates of the 6 PHS in the RP was analyzed.
Results There was a statistically significant difference (P<.001) between the PHS performance rates of NP and RP at the beginning. The intervention resulted in improved PHS performance rates in the RP; compared with the NP at the end of the study no statistical difference was noted between the groups.
Conclusions Despite various task force recommendations, PHS performance rates are generally suboptimal in varied clinic settings, including those of resident practices in teaching hospitals. Physicians and residents believe in the importance of health maintenance but fall short of their ideal in practice. Interventions to improve performance rates have been described; we are detailing a simple, inexpensive, and practical method that achieved positive results.
From the Division of General Internal Medicine, Department of Medicine, Wayne State University School of Medicine (Drs Cardozo and Steinberg, and Mr Aranha), and Harper Hospital, Detroit Medical Center (Mss Lepczyk, Binns-Emerick, and Cardozo), Detroit, Mich.
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