Delivering an ounce (or more) of prevention in your office

AMA Leader Commentary. By Ronald M. Davis, MD, Oct. 22/29, 2007.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from AMA President Ronald M. Davis, MD.

According to researchers at the Centers for Disease Control and Prevention, about half of all deaths in the United States are caused by a few largely preventable behaviors and exposures.

Tobacco use, poor diet and physical inactivity, and alcohol abuse were the leading "actual" causes of death in 2000, responsible for 435,000, 365,000 and 85,000 deaths, respectively. Total mortality from those four unhealthy behaviors (885,000 deaths) accounted for 37% of the 2.4 million deaths that year, according to an article in the March 10, 2004, and a letter in the Jan. 19, 2005, issues of the Journal of the American Medical Association.

Physicians and other health care professionals can play a key role in improving patients' health behaviors through the delivery of clinical preventive services. The U.S. Preventive Services Task Force, which is supported by the Agency for Healthcare Research and Quality, has issued evidence-based guidelines for more than 90 preventive services divided into four categories -- screening, counseling, immunization and preventive medication (www.ahrq.gov/clinic/uspstfix.htm).

Kimberly Yarnall, MD, and colleagues at Duke University Medical Center estimated in an April 1, 2003, American Journal of Public Health article that primary care physicians would need to spend, on average, 7.4 hours per working day to deliver all of the USPSTF-recommended services to a panel of 2,500 patients with an age and sex distribution similar to that of the U.S. population. Obviously, asking physicians to allocate 7.4 hours of each workday to prevention alone is unrealistic, and that's one reason why a National Commission on Prevention Priorities was established, with support from the CDC and the AHRQ.

In a July 2006 American Journal of Preventive Medicine article, the NCPP ranked the importance of clinical preventive services according to two factors: