It has been noted by Healthy People 2000: National Health Promotion and Disease Prevention Objectives, that preventive services are underutilized in primary care. Four components must be present to successfully deliver preventive health care in clinical practice: knowledge, skill, attitude and organizational structure. Hensrud reviews several issues regarding the delivery of primary preventive services.
The U.S. Preventive Services Task Force recommends that prevention be discussed at each patient visit. Initially, the physician should do a health-risk appraisal of each patient. Guidelines and protocols should be established for preventive services in each practice. Reminder systems in the form of flow sheets on the front of charts and automated computer prompts can improve the delivery of preventive services. Physicians should educate patients about preventive care; however, they may enlist the help of other medical personnel to help deliver preventive services. Nurses, nurse practitioners, physician assistants, dietitians and health educators play a valuable role in patient education. Written material from professional organizations may be used to supplement verbal education. Finally, a follow-up system for test results and future preventive services should be in place.
Preventive behaviors may be improved through health promotion counseling and patient education. The six main steps for effective health promotion counseling are summarized in the accompanying table
. Important to counseling is reading the patient correctly. Some patients respond better to a “soft-sell” approach, while others benefit more from a direct approach. In either case, it is important to relay a clear message.