FAMILY PRACTICE PHYSICIANS' UTILIZATION OF SCREENING AND THE PERIODIC HEALTH EXAMINATION

Abstract

Although numerous critical reviews have recently published recommendations for which tests should and should not be used in screening for asymptomatic disease, little is known about physicians' actual screening practices. A questionnaire was developed to assess family practitioners' use of screening tests. For the study, two contrasting groups of family physicians were chosen, STFM (academic physicians) and AAFP (clincally oriented physicians).;Overall 275 responses were obtained, a 44% response rate. The results showed that for psychosocial problems, most forms of cancer, and cardiovascular disease physicians from both societies have similar screening practices. However, AAFP physicians were more likely to perform ECG, Chest X-ray, Urinalysis, and T(,4) for screening. STFM members were more likely to perform G.C. cervical culture, and tetanus/diphtheria vaccination. Physicians were also asked to report what obstacles affected their use of various tests. Generally, STFM physicians were more likely to report obstacles than physicians from AAFP. However an analysis of the relationship between obstacle report and test utilization demonstrated that only two of the nine obstacles listed in the questionnaire had an inhibitory effect on test usage. The relationship between four independent variables and screening practices was assessed. Completion of a residency in family medicine had an effect on two tests. Sex of the physician had an effect on one item. The final two factors, year of graduation from medical school and number of patients seen per week, were both strongly associated with differences in screening practices. An analysis of the differences between physicians from the two societies yielded two contrasting profiles. Generally, STFM physicians were younger, they were more likely to be involved in teaching and research, they were more likely to work in an academic medical center and they generally saw fewer patients. They performed fewer screening tests and their practices were more in accord with recent recommendations. AAFP physicians, generally, were older, they were more likely to work in private or group practice, they saw more patients, and they did more tests. Finally, questions raised by the study and areas for future research are presented.