Clinical preventive medicine in primary care: Background and practice: 1. Rationale and current preventive practices

Impressive evidence supports the value of clinical preventive medicine, def ined as the maintenance and promotion of health and the reduction of risk f actors that result in injury and disease. Primary prevention activities det er the occurrence of a disease or adverse event, eg, smoking cessation. Sec ondary prevention (screening) is early detection of a disease or condition in an asymptomatic stage so treatment delays or blocks occurrence of sympto ms, eg, mammographic detection of breast cancer. Tertiary prevention attemp ts to not allow adverse consequences of existing clinical disease, eg, card iac rehabilitation to prevent the recurrence of a myocardial infarction. Pr eventive services have decreased morbidity and mortality from both acute an d chronic conditions. However, these services are underutilized for numerou s reasons. Barriers to their use include physician, patient, and health sys tem factors. The traditional disease/treatment model should be modified to incorporate more preventive services. The subsequent 2 parts of this review will discuss suggestions for integrating primary preventive services and s creening into primary care practice.