AN OFFICE SYSTEMS-APPROACH TO CANCER PREVENTION IN PRIMARY-CARE

PURPOSE: The provision of preventive services holds a central place in primary care. Achievement of prevention standards offers a challenge. The authors address the efficacy of an office systems approach to imp roving cancer prevention and early detection services, provide a guide to assessing the appropriateness of office systems dissemination in p ractices targeted for improvement, and describe the range of dissemina tion strategies available. OVERVIEW: Preventive sen;ice office systems depend on establishing practice routines, using tools such as flow sh eets, and sharing responsibilities among practice clinicians, staff, a nd patients. Systems have been shown to be effcacious in a variety of settings. Computers provide a significant enhancement to paper-based t ools. Some practices develop office systems themselves, whereas others require external support. Before attempting to disseminate preventive services offices systems, disseminators should ensure that adequate a ssistance can be provided, that assistance follows a format that is ac ceptable to target practices, and that target practices are receptive to assistance and able to cooperate. Dissemination strategies include journal articles, continuing education programs, manuals and tool kits , facilitation, and academic detailing. The relative expense and effic acy of these approaches require further assessment. CLINICAL IMPLICATI ONS: Office systems hold promise in enhancing provision of cancer prev ention services in primary care. The practice should be approached as a team, and should include practice clinicians as web as nonclinical s taff members. Current research should provide answers over the next fe n)rears about the cost-effectiveness of various approaches and the mos t feasible ways to promote dissemination to practices that need it.