Many practicing physicians, national organizations of health care professionals, medical educators, government agencies and the public support the belief that preventive care services should be delivered by physicians. Unfortunately, most studies indicate that compliance wih recommended preventive care guidelines is low. In most intervention studies designed to increase implementation of health maintenance, the performance of screening tests, counseling and immunizations rises to only about 50 percent in eligible patients. Hahn and Berger evaluated the use of a systematic health maintenance protocol in over 1,400 patients seen in a family practice setting over an 18-month period. The results obtained with the protocol were compared with the results of “usual care.”

At the end of each patient visit, an adult health maintenance flow sheet was reviewed with the patient to determine if indicated procedures had been performed and, if so, whether the results were normal. The physician recommended procedures that had not been performed and provided a brief explanation of each. The flow sheet consisted of ten to 15 health maintenance items, including a Papanicolaou test, blood pressure reading and tetanus booster. The protocol took between two and four minutes to complete.

After 18 months, a random audit of medical records showed that physician compliance with the protocol was 97 percent in eligible patients. Patient acceptance of recommended preventive services varied from 77 percent (sigmoidoscopy) to 97 percent (cholesterol screening). The patients in the usual care group received significantly fewer preventive services.