Disease Prevention and Health Promotion Activity During Consultations by Private and Community Health Centre General Practitioners

Abstract

The aims of this study are to compare the rates of health promotion and disease prevention activity within Community Health Centre (CHC) and private general practice (GP) consultations. A prospective field¾based observation study was designed using medical students as observers. Private and CHC general practitioners involved in the teaching of the medical students in metropolitan Melbourne were observed for one week of consecutive consultations. Primary preventive interventions or behaviours during GP consultations were recorded, based on best practice guidelines. Twenty two students acted as observers. Fifty-one general practitioners were observed, 20 from CHCs and 31 from private general practices. Inter-observer reliability was satisfactory. CHC general practitioners had higher rates of overall preventive activity. Of the four broad categories of activities coded, CHC general practitioners were significantly more likely to detect patients' risk status but no more likely to conduct casefinding examinations, make test recommendations and provide advice. Among the 46 specific activities coded, CHC general practitioners were more likely to detect their patients' exercise levels and dietary details, perform a pap smear, and give advice on smoking, alcohol and diet. It was not possible to determine to what extent doctor and patient characteristics, as distinct from practice setting, were responsible for these results. While CHC general practitioners had higher levels of preventive activity, the differences were not great. Patient-initiated disease prevention is an under-reported phenomenon which deserves further attention.