Primary care physicians suggest areas of improvement for preventive services

Diet, exercise, and smoking are three contributors to patient health – and three areas that have room for improvement when primary care physicians counsel patients.

Members of the American Academy of Family Physicians (AAFP) were among respondents in survey asking rural and nonrural physicians about ways to improve preventive services delivered to patients.

The results were published in BMC Primary Care and AAFP this month published its own summary, with an invitation for other family physicians to weigh in.

“These findings can help guide future quality improvement work between and collaborations with health research teams,” corresponding author Michaela Brtnikova, PhD, MPH, said in the AAFP summary. “Knowing that family physicians felt they could most use help with primary prevention services can generate development and testing of a variety of different prevention approaches, including ones tailored for different types of practice settings.”

Asking questions

The study analyzed 326 responses from 177 rural and 149 nonrural clinicians, with 88% of them being physicians from 49 states. They were asked about activities recommended by the U.S. Preventive Services Task Force, along with peripheral vascular disease, because of local interest in that topic, and cancer survivorship.

The results showed:

• Clinicians felt the greatest need for improvement was in primary prevention behavior change counseling activities. The areas with greatest need for improvement were assessment and counseling for nutrition and dietary behavior; physical activity; and tobacco use.
• Improving five primary prevention activities – diet, exercise, smoking, with HPV discussion and vaccines, and alcohol use assessment and counseling – all ranked higher than cancer or noncancer screenings.
• There is greater need to improve cancer screening activities, than noncancer screenings.
• Among screenings, colorectal cancer had the greatest need for improvement, followed by lung cancer, breast cancer, high blood pressure, cervical cancer, lipid disorders, and peripheral artery disease.
• Cancer survivorship was an area rated as having the least need for improvement.

There was little difference in the ratings from rural and nonrural clinicians, a surprise “given the document higher levels of risk, poorer health, greater social determinants of health challenges and generally fewer resources in rural settings,” the study said.

Future research

Brtnikova said researchers and AAFP want to hear more from different family physicians about what they feel they need for primary prevention services.

“The ultimate direction will depend on the research partners involved and results of our current shared decision-making research,” she said. “We also have a proposal under review to implement a health risk appraisal and feedback web tool that helps inform patients and practices about nine different behavior change and mental health risks and individual health risks that helps patients set goals for areas they prioritize. We would welcome participation in it.”

Family physicians interested in participating are invited to contact Elise Robertson, M.A., research project manager in the AAFP’s Practice-Based Research, Innovation and Evaluation Division.

The full study, “Priorities for improvement across cancer and non-cancer related preventive services among rural and non-rural clinicians,” was published by BMC Primary Care online Sept. 9, 2022.