Page 98 - Encyclopedia of Nursing Research

CLInICAL PREvEnTIvE SERvICES n 65

generation and testing while developing Meissner, 2004; Lopez-de-Munain, Torcal,
measurement systems and using research Lopez, & Garay, 2001; Ma, Urizar, Alehegn, &
methods that capture the holism of the cli- Stafford, 2004; natarajan & nietert, 2003; C
ent and the holistic nature of the health care nelson et al., 2002; Solberg, Kottke, & Brekke,
experience. 2001; Stange, Flocke, Goodwin, Kelly, &
Zyzanski, 2000; USPSTF, 2000). A number of
Linda R. Phillips variables influence the delivery of clinical
preventive services primary care providers.
Research has shown that lack of the provision
of preventive services included clinicians’
CliniCal preventive report lack of time (Ayres & Griffith, 2007a,
2007b, 2008; Frame, 1992; Jackson, 2002), lack
serviCes of commitment to prioritize preventive ser-
vices, inadequate reimbursement for clinical
preventive services, lack of adequate clini-
Clinical preventive services are screenings, cian training, and the lack of a system to inte-
vaccinations, counseling, or other preventive grate clinical preventive services into regular
services delivered to one patient at a time by patient care (Ayres & Griffith, 2006, 2007a,
a health care practitioner in an office, clinic, 2007b, 2008; Cornuz, 2000).
or health care system (Centers for Disease Attributes of primary care such as
Control and Prevention, 2010). Timely receipt patient preference for their regular physi-
of clinical preventive services (nelson et al., cian, interpersonal communication, and

2002; Taylor-Seehafer, Tyler, Murphy-Smith, coordination of care influence the delivery
Hitt, & Meier, 2004; United States Preventive of clinical preventive services. In addition,
Services Task Force [USPSTF], 1996) can personal factors have also been found to
reduce premature mortality and morbidity. influence the delivery of clinical preventive
Evidence suggests that screening for colo- services. Clinician failure to use recommen-
rectal and breast cancer can reduce morbid- dations in the form of clinical guidelines
ity and mortality for many older patients has been explained by a perceived lack of
(Holmboe et al., 2000; Pignone, Rich, Teutsch, effectiveness, lack of familiarity with the
Berg, & Lohr, 2002; Smith et al., 2001). There content of published recommendations, the

is strong consensus that screening for colo- belief that some forms of recommended

rectal, breast, and cervical cancer, screening care do not apply in ones’ own practice,
for high blood cholesterol levels, and timely the reduced confidence that screening

receipt of adult immunizations can reduce will lead to expected outcomes, and the

the risk of premature death (Apantaku, 2000; uncertainty about which preventive ser-
Lawvere et al., 2004; nelson et al., 2002) and vices to provide to their patients (Ayres &

that tobacco use, excessive alcohol use,physi- Griffith, 2006, 2007a, 2007b; Lawvere et al.,
cal inactivity, obesity, and failure to use safety 2004; Litaker, Flocke, Frolkis, & Stange,
belts increase mortality risk (Kerlikowski 2005; Tudiver et al., 2001; USPSTF, 2000;

et al.; nelson et al., 2002; Shapiro, Seeff, & Zitzelsberger, Grunfeld, & Graham, 2004;
nadel, 2001). Zoorob, Anderson, Cefalu, & Sidani, 2001).
Although scientific evidence exists for Primary care practices are strategic
emphasizing prevention within clinicians’ avenues for initiating clinical preventive
practices, studies have shown that clinicians services. Yet, although visits to the doctor’s
often fail to provide recommended clini- office are appropriate times to advise patients
cal preventive services (Ayres & Griffith, on health behaviors, these opportunities are
2007a, 2007b, 2008; Finney Rutten, nelson, & often missed (Woolf & Atkins, 2001). Studies