Preventive content of adult primary care: do generalists and subspecialists differ?
A J Dietrich and
H Goldberg
We compared preventive care performed by 20 generalists and20 subspecialists practicing in Santa Clara and San Mateo Counties,California, by auditing charts of adult primary care patientsfor compliance with recommendations of the Canadian Task Forceon the Periodic Health Examination. Generalists and subspecialistsboth provided 49 per cent of recommended preventive services.The two groups did not differ significantly in performance ofany individual service. Performance varied widely within bothgroups. Of many factors explored, only two were associated withmore preventive services: provision of a complete physical examinationto the patient, and a physician's belief in the importance ofa given service. The "generalist vs. subspecialist" debate assumesthat a physician's specialty classification is an importantpredictor of behavior. For the performance of preventive care,this was not true in our study. Instead, physicians' beliefsand practice habits may be major determinants of the qualityof preventive care provided. These exploratory findings neededconfirmation in other settings.
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