Barriers to preventive care in general practice: the role of organizational and attitudinal factors

BACKGROUND: There are numerous barriers to preventive care. In this paper we focus on barriers related to the organization of preventive services and to the general practitioners' (GPs') attitudes and self-efficacy expectations. The prevention of cardiovascular disease was taken as a case study.

AIM: To study the organization of cardiovascular services and the attitudes and self-efficacy expectations of GPs, the relationships that exist between these factors, and the influence of practice and provider characteristics.

METHOD: A survey was conducted among 95 general practices with 195 GPs.

RESULTS: Few practices were sufficiently well-organized to provide effective preventive services. Seventy per cent of the GPs had positive self-efficacy expectations. Thirty to fifty per cent had positive attitudes. Few relationships were found between the organization of services and positive attitudes or expectations. Moreover, few relationships were found between practice and provider characteristics and barriers studied. List size played some role in the presence of barriers.

CONCLUSION: Barriers to prevention exist. Even a positive attitude or self-efficacy expectation does not automatically coincide with a practice organization equipped for prevention. Changing attitudes is probably not enough. Efforts have to be directed at the organization of services.