Put Prevention Into Practice

Chairperson:

Hurdis M. Griffith, PhD, RN, U.S. Public Health Service

Panelist:

Linda M. Harris, PhD, George Washington University

• STATEMENT OF THE SUBJECT

Research on the delivery of clinical preventive services (counseling, screening tests, and immunizations) by primary care providers demonstrates a deficit between what is recommended by major authorities and what is happening in practice. To address this problem, the U.S. Public Health Service is developing, disseminating, and evaluating an initiative, Put Prevention Into Practice (PPIP), to improve the delivery of clinical preventive services. This comprehensive, systematic approach is designed to ensure that preventive services are integrated into everyday practice and is targeted at patients, providers, and office/clinic personnel.

• KEY ISSUES, INCLUDING THE ROLE OF TECHNOLOGY

PPIP materials, including pocket-sized booklets for patients (Personal Health Guide and Child Health Guide), a book on the basics of providing clinical preventive service for providers (Clinician's Handbook of Preventive Services), and a set of office/clinic system materials (flow sheets, reminder postcards, alert stickers, perscription pads, waiting room poster, and examination room wall charts) are currently paper-based. Many groups involved in implementation of the program express the need for an automated PPIP system. Clearly, PPIP materials should be incorporated into the development of a computerized medical record, which most experts predict will not be available for several years. In the interim, a task force convened by the U.S. Public Health Service and comprised of HMO representatives is examining the issues inherent in the the development of automated systems to improve the delivery of clinical preventive services. Following its initial recommendation, a prototype of the consumer component of PPIP was developed, which includes a PPIP Home-Page on the Internet/World Wide Web.

• ROLES, RESPONSIBILITIES, AND PRIORITIES OF KEY SECTORS

1. Legislative: provide incentives for inclusion of a basic-minimum package of clinical preventive services in all legislative proposals, mandate the incorporation of research-based approaches to the deliver of clinical preventive services, such as PPIP, in Federally-funded programs, fund the development of automated systems incor orating PPIP and demonstrations of the effects of these systems on the delivery of clinical preventive services.

2. Policy: incorporate PPIP concepts in HMO report cards (HEDIS) and accreditation activities conducted by NCQA and JCAHO, include clinical preventive services in development of office-based automated programs and consumer-directed materials.

3. Providers: adopt office-based automated systems that incorporate PPIP concepts for delivery of clinical preventive services, work with ODPHP/HMO task force to develop appropriate systems.

4. Patients: demand a comprehensive approach which integrates the delivery of clinical preventive services into each medical encounter, use the PPIP Personal Health Guide and Child Health Guide to coordinate services with their clinician.

5. Health care industry: implement PPIP in health care settings, test effects of implementation, assist the PHS in the further development of the PPIP program and PPIP automated systems.