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Prev Med. 2003 Feb;36(2):131-40.

Tools, teamwork, and tenacity: an examination of family practice office system influences on preventive service delivery.

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Department of Sociomedical Sciences, Joseph L. Mailman School of Public Health, Columbia University, 722 West 168th Street, 9th Floor, New York, NY 10032, USA.



Most research examining primary care office characteristics and preventive service delivery (PSD) has evaluated preventive service aids and equipment, while generally overlooking the complex interactions among multiple office systems where multiple factors influence the overall practice. We test a theoretical model of practice influences on PSD that accounts for Tools (preventive service aids/equipment), Teamwork (office organization), and Tenacity (prevention delivery attitudes).


Office characteristics and 4454 patient visits were observed for 138 family physicians in northeast Ohio. Utilizing U.S. Preventive Services Task Force recommendations, age- and gender-specific PSD summary scores were computed for each patient and then averaged per physician. Multivariate analysis of variance tested office characteristic associations with PSD scores.


Tools were common, but most were not significantly associated with PSD scores. The Teamwork indicators of clear staff role expectations and shared vision among physician and staff existed, respectively, for 80 and 73% of physicians. A high average reported practice focus on prevention existed, despite low staff involvement in PSD (22.2%). Compared with Tools, more Teamwork and Tenacity characteristics were associated with the PSD scores.


Teamwork and Tenacity appear to be more important than Tools in delivering preventive services in primary care practices.

[Indexed for MEDLINE]

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