Prevention-oriented primary care: a collaborative model for office-based cardiovascular risk reduction

All physicians are in a unique position to influence their patients risk of coronary artery disease (CAD). The physician must first assess the degree of CAD risk, and then, collaborating with the patient, develop a CAD risk reduction strategy that is tailored to the patient's needs and likely to succeed. Prevention-oriented primary care (POPC) is a host/environment office-based model that can be used in primary care practices to accomplish this goal. This article describes a patient-physician interactive model that can be used as an office-based approach to CAD risk reduction. This model can guide the physician and patient through a collaborative approach to healthcare aimed at preventing CAD. It is based on the recognition that a clear systematic interchange between physician and patient that is evidence based and patient centered is the key to successful risk factor modification. The efficacy of this evidence-based model is currently being studied. It uses a computer software product our team developed called the ERIS/St. Joseph health risk appraisal. This article describes eight important elements of this CAD risk reduction model: 1) physician-patient interviewing/communication styles; 2) defined physician and patient roles; 3) a computerized, prevention-oriented patient history and health-risk appraisal; 4) the patient's list of his or her health priorities; 5) the physician's list of medical priorities for CAD risk reduction; 6) a shared patient-physician priority list; 7) specific intervention plans, with target goals, and critical pathways/strategies for reaching the goals; and 8) planned follow-up care with measurable and targeted outcome goals.