Preventive medicine in primary care in Israel: findings from a national survey.

OBJECTIVE: Primary care physicians are ideally placed in the health care system to implement programs for prevention and early detection of disease, and to promulgate health education. The purpose of this study was to examine the extent of preventive activities undertaken by primary care physicians in Israel, and to identify differences in the performance of these activities, based on personal and organizational characteristics, and on the breadth of general medical activities. STUDY SELECTION: A mail survey of a stratified random sample of primary care physicians was conducted. Questionnaires were received from 677 of 872 eligible physicians in the sample, for a response rate of 77.6%. Descriptive statistics and logistic regression were used to analyze the relationship between personal and organizational characteristics of physicians, and their performance of preventive activities. RESULTS: The results of the study indicate that 68.2% of the physicians screened for hypertension, and that smoking and diet education were performed by 78% and 68%, respectively. Cholesterol screening and breast examinations were performed by between 40% and 59%, respectively. Specialists and residents in family medicine, women physicians, physicians who treat a wide range of problems without referral, physicians who participate in 22+ hours of continuing medical education per month, and physicians aged 30-54 engaged in more preventive activities. Physicians with large patient lists and who worked with nurses performed more preventive activities with specially-invited groups of patients. CONCLUSIONS: There is wide variation in the performance of preventive activities in primary care in Israel. The findings indicate the positive role of training in family medicine, teamwork with nurses, and continuing medical education for the performance of preventive activities.

[The general practitioner as physician of first contact with health problems].

An aim of this study was to determine the extent to which general practitioners (GPs) are their patients' physicians of first contact (PFCs) for specific health problems. It was also designed to explain the differences between physicians who treat these problems, and those who do not, by the type of problem presented, the characteristics of the physician, and the characteristics of the environment in which the physician works. The study is based on data collected in a nationwide mail survey in 1993 among 677 GPs working in 1 or more of Israel's 4 health insurance funds. They were asked if they were their patients' PFC for 27 health problems. There was great variation in the responses to this question according to the type of health problem presented. Thus for problems such as abdominal pain or chest pain, 85% of the GPs reported being the PFC, compared with only 50% for problems of suicidal thoughts or alcohol dependence. Multivariate analysis revealed that those more likely to report being their patients' PFC for the majority of problems presented were specialists in family medicine (p < 0.001), physicians under the age of 55 (p < 0.01) and rural physicians (p < 0.05). Our findings support the model which proposes that characteristics of the physician, the type of problem presented, and characteristics of the environment influence the likelihood of the GP being the patient's PFC. The findings have implications for GP training programs designed to enable GPs to cope with the wide range of problems encountered in general practice and to provide high quality care at reasonable cost.