Preventive medicine in primary care in Israel: Findings from a national survey

Objective: Primary care physicians are ideally placed in the health care system to implement programs for prevention and early detection of disease, and to promulgate health education. The purpose of this study was to examine the extent of preventive activities undertaken by primary care physicians in Israel, and to identify differences in the performance of these activities, based on personal and organizational characteristics, and on the breadth of general medical activities. Study selection: A mail survey of a stratified random sample of primary care physicians was conducted. Questionnaires were received from 677 of 872 eligible physicians in the sample, for a response rate of 77.6%. Descriptive statistics and logistic regression were used to analyze the relationship between personal and organizational characteristics of physicians, and their performance of preventive activities. Results: The results of the study indicate that 68.2% of the physicians screened for hypertension, and that smoking and diet education were performed by 78% and 68%, respectively. Cholesterol screening and breast examinations were performed by between 40% and 59%, respectively. Specialists and residents in family medicine, women physicians, physicians who treat a wide range of problems without referral, physicians who participate in 22+ hours of continuing medical education per month, and physicians aged 30-54 engaged in more preventive activities. Physicians with large patient lists and who worked with nurses performed more preventive activities with specially invited groups of patients. Conclusions: There is wide variation in the performance of preventive activities in primary care in Israel. The findings indicate the positive role of training in family medicine, teamwork with nurses, and continuing medical education for the performance of preventive activities.