A closer look at adult female health care maintenance visits.

Background/objectives: The health care maintenance (HCM) visit is a primary vehicle for delivering preventive services in primary care, but how these visits are actually utilized is poorly understood. This paper describes the content and process of HCM visits for adult women in family medicine.

Methods: Data were collected as part of a multi-method comparative case study of 57 clinicians from 18 purposefully selected Midwestern urban, suburban, and rural practices. Descriptive observational field notes, medical records reviews, and depth interviews were used to identify the overall content,process, and style of these visits and to examine the management of additional concerns.

Results: The preventive services addressed most frequently included clinical breast exams, pelvic exams,and mammography. Cholesterol screening, flexible sigmoidoscopy, alcohol use, and vaccinations were infrequently addressed. Health habit counseling regarding obesity was inconsistent. While some encounters followed a checklist, the majority of visits were structured but open to patients'questions/concerns. An "open-ended" format was seldom utilized. Additional patient concerns were raised and addressed during the majority of HCM visits.

Conclusions: HCM visits provide unique opportunities to deliver preventive care. Physicians may need to expand the range of services offered,involve other members of the primary care team, and address competing demands to ensure more-comprehensive preventive care delivery.