Closing the treatment gap: in the community and at hospital discharge

Although most physicians agree on the value of risk reduction in patients with cardiovascular disease, preventive strategies are not being implemented as widely as they should be in current practice. Several obstacles may account for this trend: Preventive medicine is not widely encouraged or expected; urgency takes precedence over long-term severity; physicians' time per patient is severely limited; preventive services can be considered the responsibility of other healthcare professionals; and positive feedback is generally absent. Strategies for overcoming these obstacles include the systematic identification of appropriate candidates for preventive care, adequate communication with patients to increase their understanding of the need for therapy, clarification of how to take action, assistance in doing so, and reinforcement of preventive behaviors already being practiced by patients. The case-manager approach provides one effective method for implementing these strategies: Nurses assume responsibility for preventive services, working in concert with a multidisciplinary team of physicians and other specialists. Such an approach redefines risk management as a primary treatment goal, rather than an afterthought.