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Currents |16 February 1999

Putting Prevention into Practice: The Community's Role

Tom Reynolds

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Despite abundant evidence for both the effectiveness and cost-effectiveness of clinical preventive services, most remain grossly underused and represent a missed opportunity to reduce morbidity and mortality from preventable diseases. Effective delivery of preventive care relies heavily on a team effort, with health care providers and the delivery system, the community, and the patient all playing crucial roles. There are many reasons preventive services are underused. For one, physician practices are so busy treating illness that prevention frequently takes a back seat unless systems are in place to call attention to patient needs (see the 15 October 1998 Currents section).
Douglas Shenson, MD, MPH, reported that local communities can play a pivotal role in motivating people to use preventive services. Shenson is director of Sickness Prevention Achieved through Regional Collaboration (SPARC), a program involving 75 organizations and businesses in the region near the border of Connecticut, Massachusetts, and New York. SPARC promotes and monitors preventive care and focuses on about a dozen interventions of known efficacy, including childhood and adult immunizations; measurement of serum cholesterol; and screening for breast, cervical, and colorectal cancers.
According to Shenson, the rates of use of adult preventive services “are staggeringly low across the country,” particularly compared with the high compliance rate for childhood immunizations. One reason is that while children must be immunized to enter school, no similar accountability exists for adults. “Clinical preventive services fall right through the cracks between the medical care system and the public health system,” he said. In addition,...
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Reynolds T. Putting Prevention into Practice: The Community's Role. Ann Intern Med. 1999;130:336. doi: 10.7326/0003-4819-130-4-199902160-00011

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Published: Ann Intern Med. 1999;130(4_Part_1):336.

DOI: 10.7326/0003-4819-130-4-199902160-00011

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