Obstacles to family practitioners' use of screening tests: determinants of practice?

The effect of nine obstacles on family physicians' screening practices is reported. Family physicians, responding to a survey of periodic health screening practices, were asked to check the obstacles that affected their use of the screening tests listed. In the survey, 129 members of the American Academy of Family Physicians and 146 members of the Society of Teachers of Family Medicine responded. The most frequently reported obstacles to screening were cost to the patient, patient refusal, inconvenience to the patient, and lack of facilities or equipment. The tests for which the most obstacles were reported were sigmoidoscopy, tonometry, and mammography. The Society of Teachers of Family Medicine physicians were more likely to list cost, patient reluctance, inconvenience to the patient, "the literature does not recommend to use the test," time to perform the tests, and high rate of false positives and negatives. American Academy of Family physicians were more likely to report two obstacles, lack of facilities or equipment and risk to the patient. An analysis of the relationship between obstacle report and test utilization indicated that for only five of the nine obstacles were physicians who listed the obstacle less likely to use the test than physicians who did not list the obstacle. Obstacles related with decreased test use were those that affected the physician's ability to perform the test or the efficacy of the test itself while "inactive" obstacles were those that more directly affected and emanated from patients.