Preventive care in adults: Strategies for prioritization and delivery
- Anthony J Viera, MD, MPH
Anthony J Viera, MD, MPH
- Professor of Family Medicine
- University of North Carolina School of Medicine
Quality healthcare for individuals includes two fundamental elements: appropriate treatment for current illness and appropriate preventive care to attempt to lessen future health decline. Preventive health care is an important aspect of medical practice, leading to significant improvements in overall health in the United States .
Several complex issues are involved in providing effective preventive care. Clinicians need to prioritize and decide which of the many available preventive services to recommend and which to discourage to prevent harm from inappropriate tests or interventions. Clinicians also must find a way to deliver preventive services efficiently within the context of a busy clinical practice.
This topic will discuss the approach to prevention and how to prioritize preventive services and interventions. Basic epidemiologic principles of screening and recommendations for primary prevention of conditions that cause an important burden of suffering in adults are presented elsewhere. (See "Evidence-based approach to prevention" and "Preventive care in adults: Recommendations".)
PRIORITIZING PREVENTIVE SERVICES
Preventive services should focus on priority health problems and effective interventions (table 1). Rather than performing a standardized comprehensive examination ("full physical") on all patients, clinicians should individualize screening and prevention interventions to maximize value, which encompasses the tradeoffs between benefits, harms, and costs [2,3].
Factors to consider — Priority services may differ from patient to patient depending upon age, sex, and other risk factors. The effects of recommend preventive care interventions on longevity or quality of life vary over a 100-fold and the potential beneficial effect of any one intervention on an individual patient varies with his or her lifestyle habits, medical and family history, and other risk factors . Available tools to help clinicians prioritize preventive services include:
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