The feasibility of behavioral risk reduction in primary medical care.

This prospective study evaluated changes in patients' health-risk behavior one year after preventive intervention by primary care physicians. The trial used a quasiexperimental design with 2,218 adults (1,409 study subjects and 809 controls) at five multispecialty, group practice sites in three regions of the United States. Pre- and postintervention surveys showed that the treated study patients with behavioral risks were more likely to report positive changes than were controls in regard to beginning regular exercise (P = .02), using auto seat belts, (P less than .001), losing weight (P = .05), decreasing alcohol intake (P = .01), and to performance of monthly breast self-examination by women (P less than .001). The smoking cessation rate was greater among the treated study group compared with the controls, although the change was not significantly different. Greater behavioral risk changes also occurred among the total study group (treated and untreated) in comparison with the control group. An additive index of these behavioral risks showed greater reduction among the treated and the total group of study patients compared with controls. These initial results suggest that clinical preventive services, which include risk factor education and counseling by primary care physicians, can improve short-term health-related behavior of patients.

Prevention and health promotion in primary care: baseline results on physicians from the INSURE Project on Lifecycle Preventive Health Services.

The INSURE Project on Lifecycle Preventive Health Services is a 3-year feasibility study to develop and test a clinical model of preventive health services, including patient education, in primary medical care as an insurance benefit. Seventy-four primary care physicians in group practices were surveyed regarding their baseline attitudes toward, and practice of, preventive services. Physicians report that they tend to be conscientious in educating their patients about their health risks, although they spend little time in patient education. Physicians are not sanguine about their success in getting their patients to follow their recommendations and tend to harbor doubts about their own efficacy in these areas. Specialty differences exist in these parameters. Physicians evidence contradictory attitudes about prevention. They believe doctors should spend more time providing preventive services but also believe that the lack of insurance reimbursement is an obstacle to providing these services. The concept of structural or sociological ambivalence is advanced to explain this pattern.

The INSURE Project on Lifecycle Preventive Health Services: cost containment issues.

The INSURE Project on Lifecycle Preventive Health Services (LPHS) is a three-year feasibility study to determine whether preventive health services can be implemented in the primary medical care setting as a covered health insurance benefit and what the short-term behavioral effects will be on physicians and their patients. Thus far, the negotiated reasonable and customary fees that have been paid are lower than anticipated. Patients have expressed a willingness to pay extra for preventive care insurance coverage if it were available. The positive reactions of providers and consumers and the reasonable cost of LPHS may prove to be more crucial than broader cost containment issues in determining the extent of health insurance coverage for preventive care in the future.

The INSURE project on lifecycle preventive health services.

The INSURE Project on Lifecycle Preventive Health Services is a 3-year study to determine the feasibility of implementing preventive services in primary medical care as a health insurance benefit and to assess the short-term impact of this implementation on providers and consumers. Initiated by the life and health insurance companies, the project has received additional support from private philanthropic foundations. Preventive services, which will be provided under a lifecycle approach according to the age and sex of the patient and include education of patients on health-related behavior, will range from prenatal care through geriatrics. A quasi-experimental design will be used in which three study (experimental) group practice sites are matched with three control group practice sites. At the study sites, the primary care physicians will participate in orientation sessions on recommended preventive services and patient education procedure; they will also examine and counsel the study patients. The study and control physicians and patients will be surveyed before and after the program of intervention is conducted at the study sites to assess their knowledge, attitudes, and behavior toward health behavior practices.

Physician performance in a prepaid health plan: results of the peer review program of the Health Insurance Plan of Greater New York.

A peer review program to evaluate the quality of medical care was established by the Health Insurance Plan of Greater New York in 1973. Physician performance is assessed through application of explicit process criteria to medical care as recorded in the patient record. A total of 6,788 records were reviewed in terms of the clinical management of acute otitis media, hypertension and breast lesions. Follow-up procedures to bring about positive changes in delivery of health care were integrated into the program at the time of the initial audit. Reaudit of 715 records were used to measure change in physician compliance with medical care standards. Results of this audit/reaudit process demonstrated statistically significant improvement in quality of clinical practice as measured by the assessment parameters.