How important are clinician and nurse attitudes to the delivery of clinical preventive services?

BACKGROUND: The purpose of this study was to determine the relation between primary care clinic physician and nurse attitudes toward preventive services and the rates at which their clinics provide these services to their adult patients.
METHODS: Forty-four private primary care clinics contracting with the sponsoring health maintenance organizations were recruited for a randomized controlled trial of an intervention consisting of training and consultation in continuous quality improvement and office prevention systems. Before the intervention began, 647 clinic physicians, midlevel practitioners, and nurses in the 44 participating clinics completed a questionnaire addressing their attitudes toward prevention, and 6830 patients visiting those clinics completed a questionnaire about their own up-to-date preventive care status as well as clinic actions to provide eight important preventive services during the visit. Scales were developed from significantly intercorrelated sets of attitude questions. Correlations were calculated by clinic for the relation between mean provider scores on those scales and specific service rates.
RESULTS: The questionnaire provided three scales with high internal consistency reliabilities that appear to measure generally favorable attitudes toward preventive services and toward improving them in an organized way. There was little association between these attitudes and rates of providing preventive services.
CONCLUSIONS: While favorable attitudes may be helpful, they are clearly insufficient to affect the actual delivery of preventive services. There is reason to believe that preventive services rates could be improved more effectively by targeting factors related to the provision of preventive services, particularly those that shape the clinical environment in which clinicians work.

RCT Entities:   Population Interventions Outcomes