Prevention and early detection activities in primary care: new directions for implementation

Physicians in primary care generally do not perform recommended prevention and early detection services. Many factors influence the utilization of these services; however, often not considered and/or well understood is the very process whereby these services are adopted within the primary care setting. Understanding the process, and factors affecting the process, suggest new directions for designing and implementing effective intervention strategies which increase the use of such services. New directions include the importance of identifying a discrepancy between what the practice is doing vis-à-vis what it should be doing as the first stage in the adoption process; the identification of the particular stage within the overall adoption process which best characterizes the practice and tailoring specific interventions to the requirements of that stage; emphasizing the reshaping of work actually performed within the practice beyond simply changing knowledge and attitudes of physicians and support personnel; recognition that there is a changing set of expectations to which the practice is at risk to be held accountable in any litigation; and finally that the interventions have realistic time expectations.