How primary health care providers can integrate cancer prevention into practice

Integrating prevention into practice is an important primary care challenge. Cancer prevention is a major part of this effort. In the past decade, concepts of selective longitudinal health maintenance have replaced the previous teaching that all adults should have a "complete annual physical." Physician barriers to implementing prevention include: uncertainty about conflicting recommendations; uncertainty about the value of screening tests; disorganized medical records; delayed or indirect gratification from screening; and lack of time. The following practice strategies can help overcome these barriers: adopting a scientifically based minimum core of preventive procedures; clearly identifying responsibility for prevention; engaging the patient in the responsibility for prevention; and committing resources to institutionalize prevention in the practice. The manual health maintenance flow chart is the most common tool for facilitating health maintenance tracking; however, computerized systems are being developed. The advantages and disadvantages of both types of system are addressed. A model computerized health maintenance tracking system is presented.