RESUMEN
BACKGROUND: Preventive medicine and health education are among the strategies used in coping with chronic diseases. However, it is yet to be determined what effect do personal and organizational aspects have on its' implementation in primary care. METHODS: A cross-sectional survey was conducted in order to assess and compare preventive medicine and health education activities in three types of primary care models: solo working independent physicians, nurse-physician collaborations and teamwork (nurses, dietitians and social workers working alongside a physician). Questionnaires were emailed to 1203 health professionals between September and November 2015, working at Maccabi Healthcare Services, the second largest Israeli healthcare organization. Self-reported rates of health education groups conducted, proactive appointments scheduling and self-empowerment techniques use during routine appointments, were compared among the three models. Independent variables included clinic size as well as health professionals' occupation, health behaviors and training. A series of multivariate linear regressions were performed in order to identify predictors of preventive medicine and health education implementation. Computerized health records (CHR) validated our self-report data through data regarding patients' health behaviours and outcomes, including health education group registration, adherence to occult blood tests and influenza vaccinations as well as blood lipid levels. RESULTS: Responders included physicians, nurses, dietitians and social workers working at 921 clinics (n = 516, response rate = 31%). Higher rates of proactive appointments scheduling and health education groups were found in the Teamwork and Collaboration models, compared to the Independent Physician Model. Occupation (nurses and dietitians), group facilitation training and personal screening adherence were identified as preventive medicine and health education implementation predictors. Group registration, occult blood tests, healthy population's well-controlled blood lipids as well as influenza vaccinations among chronically ill patients were all significantly higher in the Teamwork and Collaboration models, compared to the Independent Physician Model. CONCLUSIONS: The Teamwork and Collaboration models presented higher rates of preventive medicine and health education implementation as well as higher rates of patients' positive health behaviours documented in these models. This suggests multidisciplinary primary care models may contribute to population's health by enhancing preventive medicine and health education implementation alongside health professionals' characteristics.
