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Diagnosis and Treatment |

Internists' Practices in Health Promotion and Disease Prevention: A Survey

J. Sanford Schwartz, MD; Charles E. Lewis, MD, ScD; Carolyn Clancy, MD; Monica S. Kinosian, MHS; Margaret H. Radany, MPP; and Jeffrey P. Koplan, MD, MPH
[+] Article and Author Information

Grant Support: By the Centers for Disease Control, Atlanta, Georgia.

Requests for Reprints: J. Sanford Schwartz, MD, Leonard Davis Institute of Health Economics, Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104.

Current Author Addresses: Dr. Schwartz: Leonard Davis Institute of Health Economics, Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104.

Dr. Lewis: Department of Medicine, UCLA School of Medicine, Los Angeles, CA 90024.

Dr. Clancy: Box 254, MCV Station, Richmond, VA 23298-0254.

Ms. Kinosian: The Wharton School, Department of Public Policy and Management, Philadelphia, PA 19104.

Ms. Radany: Institute for Health Policy Studies, UCSF, 1326 3rd Avenue, San Francisco, CA 94143.

Dr. Koplan: Centers for Disease Control (A37), 1600 Clifton Road, Northeast, Atlanta, GA 30333.


Ann Intern Med. 1991;114(1):46-53. doi:10.7326/0003-4819-114-1-46
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Objective: To estimate internists' use of disease prevention and health promotion activities, and to explore demographic, professional, behavioral, psychological, cognitive, and organizational factors associated with the use of such practices.

Design: Mail survey.

Setting and Subjects: A sample of 2610 members and fellows of the American College of Physicians (ACP) participated in the study. They engaged in patient care activities more than 20 hours per week and were stratified by gender and region. They lived in four geographic areas of the United States (Northeast, Southeast, Central, and West), comprising 21 ACP regions.

Measurements: A questionnaire requesting background information as well as information about personal health; record keeping; use of immunizations (pneumococcal, influenza, tetanus, hepatitis B); use of screening tests and procedures for detecting cancer (breast examination, Papanicolaou smear, stool occult blood test) and other diseases (electrocardiograms, cholesterol level tests, chest radiographs); and behavioral counseling to promote health (in the areas of smoking, exercise, and alcohol and seat belt use).

Main Results: Internists used effective preventive interventions less frequently and ineffective practices more frequently than experts recommend. Internists' use of health promotion and disease prevention activities is associated with habit, attitude, and a lack of adequate knowledge. Younger physician age, general internal medicine practice, and personal health promotion and disease prevention practices were strongly associated with more appropriate use of recommended practices (P < 0.01).

Conclusions: Internists' use of disease prevention and health promotion activities falls short of expert recommendations. Programs to improve the delivery of preventive services might be aimed at improving physicians' personal health practices, might be directed toward patients, and might include the development of effective systems to remind physicians.

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