Background: Delivery of preventive services sometimes falls short of guideline recommendations. Purpose: To evaluate the multilevel factors associated with evidence-based preventive service delivery during periodic health examinations (PHEs). Methods: Primary care physicians were recruited from an integrated delivery system in southeast Michigan. Audio recordings of PHE office visits conducted from 2007 to 2009 were used to ascertain physician recommendation for or delivery of 19 guideline-recommended preventive services. Alternating logistic regression was used to evaluate factors associated with service delivery. Data analyses were completed in 2011. Results: Among 484 PHE visits to 64 general internal medicine and family physicians by insured patients aged 5080 years, there were 2662 services for which patients were due; 54% were recommended or delivered. Regression analyses indicated that the likelihood of service delivery decreased with patient age and with each concern the patient raised, and it increased with increasing BMI and with each additional minute after the scheduled appointment time the physician first presented. The likelihood was greater with patientphysician gender concordance and less if the physician used the electronic medical record in the exam room or had seen the patient in the past 12 months. Conclusions: A combination of patient, patient-physician relationship, and visit contextual factors are associated with preventive service delivery. Additional studies are warranted to understand the complex interplay of factors that support and compromise preventive service delivery.
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