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Primary Care: Is There Enough Time for Prevention?
Open accessAbstract
Objectives. We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel. Methods. We used published and estimated times per service to determine the physician time required to provide all services recommended by the US Preventive Services Task Force (USPSTF), at the recommended frequency, to a patient panel of 2500 with an age and sex distribution similar to that of the US population. Results. To fully satisfy the USPSTF recommendations, 1773 hours of a physician’s annual time, or 7.4 hours per working day, is needed for the provision of preventive services. Conclusions. Time constraints limit the ability of physicians to comply with preventive services recommendations.
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“A 5 A’s approach has been shown to produce significant changes in a variety of health behaviors, including smoking cessation, dietary change, and physical activity.13,26,38–44”
From Better Population Health Through Behavior Change in Adults: A Call to Action (2013) · cites this paper as [44]
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“In clinical practice, however, time constraints may make opportunistic delivery of indicated preventive services impractical.(2) Meanwhile, patients and physicians strongly endorse preventive visits as a means of improving health and building trust.”
BackgroundRoutine assessment of family and community health risks: parent views and what they receive.
Kogan, M. D., Schuster, M. A., Yu, S. M., Park, C. H., Olson, L. M., Inkelas, M., Bethell, C., Chung, P. J., & Halfon, N. (2004) · Pediatrics · doi:10.1542/peds.113.s5.1934 · Cited by 60
“Financial difficulties 12 (232) 63 (1248) 24 (485) 1 (17) 100 (1982) Community violence 9 (167) 47 (873) 42 (804) 2 (31) 100 (1875)”
Mold, J. W., Aspy, C. A., & Nagykaldi, Z. (2008) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2008.04.080006 · Cited by 61
Shah, M. N., Caprio, T. V., Swanson, P. A., Rajasekaran, K., Ellison, J. H., Smith, K., Frame, P., Cypher, P., Karuza, J., & Katz, P. R. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.03137.x · Cited by 64
Meissner, H. I., Tiro, J. A., Yabroff, K. R., Haggstrom, D. A., & Coughlin, S. S. (2010) · Medical Care · doi:10.1097/mlr.0b013e3181ca4015 · Cited by 62
Findley, P. A., & Sambamoorthi, U. (2008) · Journal of Cancer Survivorship · doi:10.1007/s11764-008-0074-x · Cited by 62
“This needs particular attention as studies have evidenced that physicians’ time to provide preventive services is limited [ 56 ].”
BackgroundStoutenberg, M., Stasi, S., Stamatakis, E., Danek, D. J., Dufour, T., Trilk, J. L., & Blair, S. N. (2015) · The Physician and Sportsmedicine · doi:10.1080/00913847.2015.1084868 · Cited by 62
“While there is increasing pressure on medical programs to teach a wide variety of preventive practices [26], it is imperative that innovative solutions be developed to provide medical students training in PA.”
BackgroundWake, D. T., Ilbawi, N., Dunnenberger, H. M., & Hulick, P. J. (2019) · Medical Clinics of North America · doi:10.1016/j.mcna.2019.07.002 · Cited by 62
Hofer, T. P., Zemencuk, J. K., & Hayward, R. A. (2004) · Journal of General Internal Medicine · doi:10.1007/s11606-004-0058-0 · Cited by 62
Emergency contraception: A multispecialty survey of clinician knowledge and practices
Batur, P., Cleland, K., McNamara, M., Wu, J. P., & Pickle, S. (2015) · Contraception · doi:10.1016/j.contraception.2015.09.003 · Cited by 61
“Competing demands within the constraints of a brief medical visit limit the time available to discuss reproductive health concerns [23,24].”
BackgroundPrioritization of Evidence-Based Preventive Health Services During Periodic Health Examinations
Shires, D. A., Stange, K. C., Divine, G., Ratliff, S. M., Patel, R. V., Tai‐Seale, M., & Lafata, J. E. (2012) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2011.10.008 · Cited by 61
Provider Workload and Quality of Care in Primary Care Settings
Mohr, D. C., Benzer, J. K., & Young, G. J. (2012) · Medical Care · doi:10.1097/mlr.0b013e318277f1cb · Cited by 61
Personalized Estimates of Benefit From Preventive Care Guidelines
Taksler, G. B., Keshner, M., Fagerlin, A., Hajizadeh, N., & Braithwaite, R. S. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-159-3-201308060-00005 · Cited by 61
Yoast, R. A., Wilford, B. B., & Hayashi, S. (2008) · Journal of Addictive Diseases · doi:10.1080/10550880802122687 · Cited by 63
Wade, C. H., Tarini, B. A., & Wilfond, B. S. (2013) · Annual Review of Genomics and Human Genetics · doi:10.1146/annurev-genom-091212-153425 · Cited by 61
Marra, M. V., Lilly, C. L., Nelson, K. R., Woofter, D. R., & Malone, J. (2019) · Nutrients · doi:10.3390/nu11020229 · Cited by 61
“However, delivery in primary care is limited by competing demands on the primary care practitioner (PCPs) time, lack of behavioral counseling skills and lack of resources to deliver on-site intensive comprehensive programs [8,9].”
BackgroundBarriers to the Adoption and Implementation of Preventive Dental Services in Primary Medical Care
Close, K., Rozier, R. G., Zeldin, L. P., & Gilbert, A. R. (2010) · PEDIATRICS · doi:10.1542/peds.2009-1008 · Cited by 61
The myth of standardized workflow in primary care
Holman, G. T., Beasley, J. W., Karsh, B., Stone, J. A., Smith, P. D., & Wetterneck, T. B. (2015) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv107 · Cited by 60
“Other studies have evaluated the amount of time PCPs “should” spend on prevention and chronic care.(23,24) The number of patient problems addressed per primary care visit(25) and the numbers of different patient problems addressed and tasks performed per patient visit have also been evaluated.”
BackgroundWald, J. S., Businger, A., Gandhi, T. K., Grant, R. W., Poon, E. G., Schnipper, J. L., Volk, L. A., & Middleton, B. (2010) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2009.001362 · Cited by 62
“Primary care physicians have much to accomplish in the limited time of a patient visit.”
BackgroundSteel, A., Foley, H., Bradley, R. D., Venter, C. V. D., Lloyd, I., Schloss, J. M., Wardle, J., & Reid, R. (2020) · BMC Complementary Medicine and Therapies · doi:10.1186/s12906-020-2851-7 · Cited by 60
Expanding developmental and behavioral services for newborns in primary care
Johnston, B., Huebner, C. E., Tyll, L. T., Barlow, W. E., & Thompson, R. S. (2004) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2003.12.018 · Cited by 61
Prevalence and Correlates of High-Quality Basic Pediatric Preventive Care
ZUCKERMAN, B. S., Stevens, G. D., Inkelas, M., & Halfon, N. (2004) · PEDIATRICS · doi:10.1542/peds.2004-0635 · Cited by 60
Unintended Consequences of Resource-Based Relative Value Scale Reimbursement
Goodson, J. D. (2007) · JAMA · doi:10.1001/jama.298.19.2308 · Cited by 60
“Providing all recommended preventive services to a panel of 2500 patients could require up to 71⁄2 hours a day of physician time.(8) Generalist physicians report that roughly 4 separate problems are addressed at each office visit for patients older than 65 years and even more issues are addressed for patients with chr…”
BackgroundMinimal, negligible and negligent interventions
Hawe, P. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.05.025 · Cited by 60
Metadata
- Authors
- Yarnall, K. S. H., Pollak, K. I., Østbye, T., Krause, K. M., & Michener, J. L.
- Affiliations
- Duke University (US)
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 2003-04
- Volume
- 93
- Issue
- 4
- Pages
- 635-641
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- PMC
- PMC1447803
- OpenAlex
- W2166751697
- Cited by
- 1,641
- References
- 59
- Citations by year
- 2026: 22 · 2025: 23 · 2024: 40 · 2023: 50 · 2022: 77 · 2021: 66 · 2020: 71 · 2019: 67 · 2018: 74 · 2017: 87 · 2016: 79 · 2015: 105 · 2014: 84 · 2013: 95 · 2012: 98
- FWCI
- 57.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh056846-03)
- National Institute of Mental Health (5 R01 MH56846-03)
- National Cancer Institute (CA 14236, P01 CA 72099, P01CA072099, P30CA014236)
- National Institute of General Medical Sciences (R01GM056846)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- preventive services, primary care, physician time constraints, USPSTF recommendations, time allocation, patient panel
- MeSH terms
- Adolescent, Adult, Aged, Appointments and Schedules, Child, Child, Preschool, Counseling, Female, Health Services Research, Humans, Infant, Infant, Newborn, Male, Middle Aged, Preventive Health Services, Primary Health Care, Primary Prevention, Time and Motion Studies, United States, Models, Statistical
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