Manuti et al. BMC Public Health 2010, 10:350 http://www.biomedcentral.com/1471-2458/10/350 Table 3: Logistic regression models results (Continued) PCP§ medical visits 1.74 in the previous year, ordinal† Specialist visits in community health services None* ≥1 Private specialist visits, None* ≥1 Emergency accesses - in the previous year, None* ≥1 Hospital admissions in the previous year None* ≥1 (1.34-2.25) 1.00 1.49 (1.07-2.08) - 1.00 1.33 (0.79- 2.23) 1.32 (0.95-1.82) 1.00 1.34 (0.84-2.13) - - 1.00 2.80 (1.66-4.72) 1.11 (0.88-1.40) - 1.00 1.37 (1.00-1.89) 1.00 0.76 (0.52-1.11) - - - - 1.00 0.74 (0.39-1.38) 1.00 2.71 (1.14-6.46) - - - - - Page 7 of 10 1.30 (1.04-1.62) 1.00 1.46 (1.08-1.98) - 1.00 1.37 (0.99-1.90) - * reference category; § PCP = primary care physician; ° Number in households: (none = 0, 1 = 1, >1 = 2); # Education level: (no formal education = 1, primary school = 2, secondary school = 3, high school or higher = 4); ~ Current tobacco use: (not at all = 0, some days = 1, every day = 2); † PCP medical visits in the previous year: (none = 0, <1 time per month = 1, ≥1 time per month = 2) a regular care provider [48]. Coverage for cancer screen- ing is probably so low due to the lack of an organised screening program in our Southern region; this is con- firmed by studies conducted in Italy that have demon- strated an unmistakable imbalance in the provision of breast, cervical and colorectal cancer screening in Southern Italy [7-9]. We found only two clinical preventive services, blood pressure screening and the recommendation of influenza vaccination in subjects aged 65 and over, that showed satisfactory adhesion, reaching rates similar to or higher than most reported studies [3,36,49,50]. The high rate for screening of hypertension may correlate with many factors, such as simplicity and availability of blood pres- sure measurement, commonly performed with a sphyg- momanometer, and to the global awareness of the importance of this clinical service not only by the indivi- dual physician but also by patients who did state in the interviews, that they often requested a blood pressure measurement. The high rates of recommendation of influenza vacci- nation may reflect a positive attitude of PCPs, and are in accordance with findings of a previous study con- ducted by some of us in the same area, that indicated positive knowledge, attitudes and behaviours on vaccina- tions in the elderly in a large majority of PCPs [51]. Moreover, with respect to provision for screening and counseling on health habits services, we found that the rates were drastically lower than those reported in sev- eral studies conducted in the United States [3,15,16,52-54]. Several factors relating to the individual physician or patient may be mentioned as impediments to the provision of these services: lack of opportunity, lack of time due to other health concerns, the physi- cian’s negative attitude towards prevention or antici- pated patient refusal; in defense, however, patients may not remember being asked about these conditions since they seemed not overly concerned about them. Consistent with previous studies [43-47,55-59], we found significant disparities in the delivery of clinical preventive services. Primary care access measures, as well as proxies for the propensity to seek or request care, were all directly related to delivery of clinical pre- ventive services, thus proving that more and better access to primary health care increases the likelihood of delivery of clinical preventive services. Therefore, our results strongly confirm the crucial role of PCPs in promoting preventive services, and agrees with