Increasing preventive care in general practice: an examination

This thesis aimed to explore a method of changing health care providers' clinical behaviour. As Kane and Garnard have noted, "Changing physicians' behaviour is not easy" (p. 393). As a result, despite the promulgation of various written guidelines which strive to direct doctors toward "best-practice", little is known of the influences on medical behaviour. More specifically, this thesis consists of a series of integrated empirical studies and literature reviews designed to identify some effective strategies for encouraging the uptake of preventive care guidelines by general practitioners. Data from the studies discussed in this thesis were collected during 1994 and 1995. The research embodied in the thesis contributes to the growing understanding of the influences underlying preventive care provision by primary care practitioners. One important contribution was the development of a practical strategy for encouraging general practitioners to promote preventive health in their practice. The computer CME program was not designed to re-orientate general practice offices in itself, but rather offers a shortterm strategy which can be used intermittently and for different behaviours to impact on practices. The results of evaluations of the program presented in Chapters 4 and 5 showed that components of the program were accurate for some behaviours, reliable and acceptable to patients. Evaluations reported in Chapter 6 indicate that the program is effective in improving some behaviours, reasonably acceptable to practitioners and reception staff and feasible. Second, the project provided a contribution to the information about the effectiveness of CME strategies, providing clear guidelines for program development. Chapter 6 demonstrated that a computer based CME program can be effective at changing practitioner preventive behaviours. Also, Chapters 3 and 6 demonstrated that the use of strategies based on theories of dissemination of innovation, information transfer, and adult behaviour change can increase the likelihood of successful CME. The strategies applied in the computer CME program included; provision of a strong rationale for the need for prevention, definition of the target behaviours in clear and concrete terms, setting of performance goals, tailoring, provision of performance-related feedback, and peer comparison. Implications and recommendations for future research are discussed in Chapter 6. To facilitate consistency, links are made across chapters, however, each has been written as a relatively self-contained unit for the reader's convenience.