Acting on synergies between clinic and community strategies to improve preventive medicine
“The normal physician treats the problem; the good physician treats the person; the best physician treats the community.”
—Chinese proverb1
Drawing on both arenas to prioritize prevention strategies
The federal government has supported the development of several types of evidence-based prevention guidelines. Family physicians are familiar with the US Preventive Service Task Force Guide to Clinical Preventive Services,3 but may be less familiar with the more recently developed Guide to Community Preventive Services.4 For a comprehensive continuum of preventive care, both guides can be used in combination. Using both sets of recommendations can help physicians to prioritize prevention strategies for individuals, office patient populations, and communities.
The Community Guide is a federally sponsored initiative producing evidenced-based recommendations for health promotion and disease prevention from a population-based perspective sponsored by the Centers for Disease Control and Prevention (Table 1). Like the Guide to Clinical Preventive Services, the independent task force that oversees the Community Guide develops evidence-based reviews of potential interventions and translates the findings into recommendations that can be used by policy makers, public health entities, and health systems.
TABLE 1
Topics covered in the Guide to Community Preventive Services
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Actionable recommendations for practitioners
Though the Community Guide takes a population-based approach to prevention (eg, recommendations for policy strategies, mass media campaigns, and school health programs), a number of its recommendations focus on the health care system and are directly applicable to practicing family physicians. For instance:
- Vaccination: a section on provider-based interventions such as reminder systems, standing orders for adults, and provider feedback strategies
- Diabetes: a section on disease management strategies
- Tobacco: a section on improving the delivery of cessation services
- Cancer: a section on improving screening for specific diseases.
The topic reviews grade the strength of each intervention (strong evidence, sufficient evidence, or insufficient evidence), provide a 1-page summary of the recommendations, and have links to longer papers that review the specific evidence.
Complementary web support
The website also includes an excellent 2-page summary of types of activities family doctors can undertake, with links to specific directions for implementing prevention activities. Included are patient and provider reminder systems, disease and case management, and use of standing orders.4
The recommendations in both the Clinical and Community Guides that address common conditions provide especially strong “roadmaps” for focusing on and addressing health promotion and disease prevention. By using both guides, physicians can develop a range of effective, evidence-based approaches for practice. For example, Table 2 presents evidence-based recommendations concerning smoking. These recommendations fall across a range of preventive interventions.
Producing successful initiatives
Using the guides as a reference, the family physician could initiate screening of patients for smoking status in the practice and then implement one or more of the recommended strategies listed in Table 2. Possibilities include adding a provider reminder system, delivering brief counseling to quit smoking, prescribing cessation medications, and coupling these efforts with advocacy for development of a media campaign in the community. Family physicians who undertake community prevention efforts outside the office setting are likely to improve their success by partnering with other community health and social service professionals to implement agreed upon prevention interventions.5
As more topics are developed for the Community Guide, family physicians will likely find more reasons to refer to it as a companion to the Clinical Guide. Using the 2 together will enhance the benefit gained from using each alone in a way that is analogous to the added health benefits obtained when the traditional health care system works more closely with the public health system.
TABLE 2
Intervention strategies in the clinical and community guides
| Intervention strategy recommendation | Where it’s found | Where it’s to be used |
|---|---|---|
| Screening patients for tobacco use | Clinical Guide | Office |
| Provider gives brief advise to quit to patients who use tobacco | Clinical Guide | Office |
| Provider counseling to patients on tobacco cessation | Clinical Guide | Office |
| Self-help education materials for patients who use tobacco | Clinical Guide | Office |
| Pharmacologic treatment for tobacco and dependence | Clinical Guide | Office |
| Provider reminder systems | Community Guide | Office |
| Multicomponent clinical program (provider reminder + education) | Community Guide | Office |
| Patient-oriented interventions (telephone support; sliding fee scale) | Community Guide | Office |
| Policies, regulations, and laws (smoking ban and restrictions) | Community Guide | Community |
| Mass media campaigns | Community Guide | Community |
| Sources: Adapted from USPSTF, Guide to Clinical Preventive Services, 19963; | ||
| USPSTF, Guide to Community Preventive Services, 2000.4 | ||
Correspondence
Eric Henley, MD, MPH, 1601 Parkview Avenue, Rockford, IL 61107. E-mail: ehenley@uic.edu.
