Primary care practice organization and preventive services delivery: A qualitative analysis

Benjamin F. Crabtree, William L. Miller, Virginia A. Aita, Sue Flocke, Kurt C. Stange

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Background. Rapid developments within the health care environment have led to increased pressures for change among primary care physicians and their practices. Nevertheless, a lack of understanding of practice organization and function has limited the effectiveness of attempts to change practice behaviors. Recent attempts to increase the delivery of preventive health care services illustrate the limitations of current approaches. To assist physicians in their attempts at change, our study looked at the office as a whole system and at the competing demands within the primary care setting. Methods. Qualitative fieldnotes were recorded by research nurses who observed 138 family physicians in 84 practices in northeast Ohio for 4 days each. These data were content-analyzed to identify features that are important for understanding how practices are organized. Results. These data indicate that primary care practice is much more complex than research and transformation efforts generally acknowledge. The data identified a diverse set of features that describe how primary care practices are organized and function. These included cognitive and behavioral components of physician philosophy and style, and numerous features of the practice organization, such as office efficiency, clarity of staff roles, communication patterns among physicians and staff, and approaches to using office protocols. The data also suggest that some practices are more innovative than others and that some physicians or staff have special motivations that can support or inhibit a particular change. Conclusions. Physicians who want to change their practice, as well as those persons who want to stimulate change from the outside, need to have a more comprehensive approach than is now commonly used to assess practices that encompass a broad spectrum of variables.

Original languageEnglish (US)
Pages (from-to)403-409
Number of pages7
JournalJournal of Family Practice
Volume46
Issue number5
StatePublished - May 1 1998
Externally publishedYes

Fingerprint

Primary Health Care
Physicians
Preventive Health Services
Delivery of Health Care
Family Physicians
Primary Care Physicians
Research
Motivation
Nurses
Communication
Pressure

Keywords

  • Family practice
  • Physician's practice patterns
  • Practice management, medical
  • Preventive health services
  • Systems theory

ASJC Scopus subject areas

  • Family Practice

Cite this

Crabtree, B. F., Miller, W. L., Aita, V. A., Flocke, S., & Stange, K. C. (1998). Primary care practice organization and preventive services delivery: A qualitative analysis. Journal of Family Practice, 46(5), 403-409.

Primary care practice organization and preventive services delivery : A qualitative analysis. / Crabtree, Benjamin F.; Miller, William L.; Aita, Virginia A.; Flocke, Sue; Stange, Kurt C.

In: Journal of Family Practice, Vol. 46, No. 5, 01.05.1998, p. 403-409.

Research output: Contribution to journalArticle

Crabtree, BF, Miller, WL, Aita, VA, Flocke, S & Stange, KC 1998, 'Primary care practice organization and preventive services delivery: A qualitative analysis', Journal of Family Practice, vol. 46, no. 5, pp. 403-409.
Crabtree, Benjamin F. ; Miller, William L. ; Aita, Virginia A. ; Flocke, Sue ; Stange, Kurt C. / Primary care practice organization and preventive services delivery : A qualitative analysis. In: Journal of Family Practice. 1998 ; Vol. 46, No. 5. pp. 403-409.
@article{2c97957f4a034272a9b6127a38f96795,
title = "Primary care practice organization and preventive services delivery: A qualitative analysis",
abstract = "Background. Rapid developments within the health care environment have led to increased pressures for change among primary care physicians and their practices. Nevertheless, a lack of understanding of practice organization and function has limited the effectiveness of attempts to change practice behaviors. Recent attempts to increase the delivery of preventive health care services illustrate the limitations of current approaches. To assist physicians in their attempts at change, our study looked at the office as a whole system and at the competing demands within the primary care setting. Methods. Qualitative fieldnotes were recorded by research nurses who observed 138 family physicians in 84 practices in northeast Ohio for 4 days each. These data were content-analyzed to identify features that are important for understanding how practices are organized. Results. These data indicate that primary care practice is much more complex than research and transformation efforts generally acknowledge. The data identified a diverse set of features that describe how primary care practices are organized and function. These included cognitive and behavioral components of physician philosophy and style, and numerous features of the practice organization, such as office efficiency, clarity of staff roles, communication patterns among physicians and staff, and approaches to using office protocols. The data also suggest that some practices are more innovative than others and that some physicians or staff have special motivations that can support or inhibit a particular change. Conclusions. Physicians who want to change their practice, as well as those persons who want to stimulate change from the outside, need to have a more comprehensive approach than is now commonly used to assess practices that encompass a broad spectrum of variables.",
keywords = "Family practice, Physician's practice patterns, Practice management, medical, Preventive health services, Systems theory",
author = "Crabtree, {Benjamin F.} and Miller, {William L.} and Aita, {Virginia A.} and Sue Flocke and Stange, {Kurt C.}",
year = "1998",
month = "5",
day = "1",
language = "English (US)",
volume = "46",
pages = "403--409",
journal = "Journal of Family Practice",
issn = "0094-3509",
publisher = "Appleton-Century-Crofts",
number = "5",

}

TY - JOUR

T1 - Primary care practice organization and preventive services delivery

T2 - A qualitative analysis

AU - Crabtree, Benjamin F.

AU - Miller, William L.

AU - Aita, Virginia A.

AU - Flocke, Sue

AU - Stange, Kurt C.

PY - 1998/5/1

Y1 - 1998/5/1

N2 - Background. Rapid developments within the health care environment have led to increased pressures for change among primary care physicians and their practices. Nevertheless, a lack of understanding of practice organization and function has limited the effectiveness of attempts to change practice behaviors. Recent attempts to increase the delivery of preventive health care services illustrate the limitations of current approaches. To assist physicians in their attempts at change, our study looked at the office as a whole system and at the competing demands within the primary care setting. Methods. Qualitative fieldnotes were recorded by research nurses who observed 138 family physicians in 84 practices in northeast Ohio for 4 days each. These data were content-analyzed to identify features that are important for understanding how practices are organized. Results. These data indicate that primary care practice is much more complex than research and transformation efforts generally acknowledge. The data identified a diverse set of features that describe how primary care practices are organized and function. These included cognitive and behavioral components of physician philosophy and style, and numerous features of the practice organization, such as office efficiency, clarity of staff roles, communication patterns among physicians and staff, and approaches to using office protocols. The data also suggest that some practices are more innovative than others and that some physicians or staff have special motivations that can support or inhibit a particular change. Conclusions. Physicians who want to change their practice, as well as those persons who want to stimulate change from the outside, need to have a more comprehensive approach than is now commonly used to assess practices that encompass a broad spectrum of variables.

AB - Background. Rapid developments within the health care environment have led to increased pressures for change among primary care physicians and their practices. Nevertheless, a lack of understanding of practice organization and function has limited the effectiveness of attempts to change practice behaviors. Recent attempts to increase the delivery of preventive health care services illustrate the limitations of current approaches. To assist physicians in their attempts at change, our study looked at the office as a whole system and at the competing demands within the primary care setting. Methods. Qualitative fieldnotes were recorded by research nurses who observed 138 family physicians in 84 practices in northeast Ohio for 4 days each. These data were content-analyzed to identify features that are important for understanding how practices are organized. Results. These data indicate that primary care practice is much more complex than research and transformation efforts generally acknowledge. The data identified a diverse set of features that describe how primary care practices are organized and function. These included cognitive and behavioral components of physician philosophy and style, and numerous features of the practice organization, such as office efficiency, clarity of staff roles, communication patterns among physicians and staff, and approaches to using office protocols. The data also suggest that some practices are more innovative than others and that some physicians or staff have special motivations that can support or inhibit a particular change. Conclusions. Physicians who want to change their practice, as well as those persons who want to stimulate change from the outside, need to have a more comprehensive approach than is now commonly used to assess practices that encompass a broad spectrum of variables.

KW - Family practice

KW - Physician's practice patterns

KW - Practice management, medical

KW - Preventive health services

KW - Systems theory

UR - http://www.scopus.com/inward/record.url?scp=0031954495&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031954495&partnerID=8YFLogxK

M3 - Article

C2 - 9597998

AN - SCOPUS:0031954495

VL - 46

SP - 403

EP - 409

JO - Journal of Family Practice

JF - Journal of Family Practice

SN - 0094-3509

IS - 5

ER -