Mayo Clinic Proceedings Home

Delivery Rates for Preventive Services in 44 Midwestern Clinics


      To determine the rates at which private primary-care clinics are recommending blood pressure and cholesterol measurement, smoking cessation, clinical breast examination, screening mammography, Papanicolaou testing, and influenza and pneumococcus immunizations.

      Material and Methods

      We conducted a mail survey of 7,997 randomly selected patients from 44 primary-care clinics in and around Minneapolis-St. Paul, Minnesota, of whom 6,830 (85.4%) completed the questionnaire on preventive services delivery rates. The responses were analyzed statistically, including stratification by reason for the clinic visit.


      On the average, about two-thirds of the patients in each clinic reported being up-to-date on preventive services before their clinic visit; an exception was pneumococcus immunization (mean rate, 33%). Except for blood pressure and smoking cessation advice, less than 30% of patients who were not up-to-date on a preventive service were offered it if the clinic visit was for a reason other than a checkup or physical examination. For patients who said that they saw their physician for a checkup or physical examination, the rate was more than 50% only for Papanicolaou smear. In contrast, nearly all responding practitioners agreed that each of the eight preventive services was very important or important.


      Preventive services consensus goals are not being met, even for patients who report that their clinic visit was for a checkup or physical examination. This finding suggests that it may be necessary to develop clinical systems that support and enable the delivery of preventive services.
      IMPROVE (IMproving PRevention through Organization, Vision, and Empowerment)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Thompson RS
        • Taplin SH
        • McAfee TA
        • Mandelson MT
        • Smith AE
        Primary and secondary prevention services in clinical practice: twenty years' experience in development, implementation, and evaluation.
        JAMA. 1995; 273: 1130-1135
        • Schoenbaum SC
        Implementation of preventive services in an HMO practice.
        J Gen Intern Med. 1990; 5: S123-S127
        • Carney PA
        • Dietrich AJ
        • Keller A
        • Landgraf J
        • O'Connor GT
        Tools, teamwork, and tenacity: an office system for cancer prevention.
        J Fam Pract. 1992; 35: 388-394
        • McPhee SJ
        • Detmer WM
        Office-based interventions to improve delivery of cancer prevention services by primary care physicians.
        Cancer. 1993; 72: 1100-1112
        • McGinnis JM
        • Griffith HM
        Put prevention into practice: a systematic approach to the delivery of clinical preventive services [editorial].
        Arch Intern Med. 1996; 156: 130-132
        • Kottke TE
        • Blackburn H
        • Brekke ML
        • Solberg LI
        The systematic practice of preventive cardiology.
        Am J Cardiol. 1987; 59: 690-694
        • Kottke TE
        • Brekke ML
        • Solberg LI
        Making “time” for preventive services.
        Mayo Clin Proc. 1993; 68: 785-791
        • Solberg LI
        Smoking cessation as a clinic quality improvement project.
        in: Shopland DR Burns DM Cohen SI Gritz E Kottke TE Tobacco and the Clinician: Interventions for Medical and Dental Practice. National Cancer Institute, Washington (DC)1994: 303-320 (Publication No. NIH 94-3693)
        • Solberg LI
        • Kottke TE
        • Brekke ML
        • Calomeni CA
        • Conn SA
        • Davidson G
        Using continuous quality improvement to increase preventive services in clinical practice-going beyond guidelines.
        Prev Med. 1996; 25: 259-267
        • Donner A
        Approaches to sample size estimation in the design of clinical trials-a review.
        Stat Med. 1984; 3: 199-214
        • Dillman DA
        Mail and Telephone Surveys: The Total Design Method. Wiley, New York1978
      1. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. US Government Printing Office, Washington (DC)1991 (Publication No. PHS 91-50212)
      2. Healthy People 2000: Midcourse Review and 1995 Revisions. US Government Printing Office, Washington (DC)1995
        • Appleby C
        Why direct contracting won't put doctors back in the saddle.
        Managed Care. 1996; 5 (24-25): 19-21
        • Wetzell S
        • Reinertsen JL
        When physicians advance on the world of managed care.
        Internist. 1996; 37: 6-9

      Linked Article

      • Correction
        Mayo Clinic ProceedingsVol. 72Issue 7
        • Preview
          In an article entitled “Delivery Rates for Preventive Services in 44 Midwestern Clinics,” which was published in the June 1997 issue of the Nlayo Clinic Proceedings (Mayo Clin Proc 1997; 72: 515-523), a few numbers in Table 5 were incorrect. The corrected table is reprinted below (corrected numbers are shown in boldface type).
        • Full-Text
        • PDF