Spitzer W O, Mann K V
McGill University, Montreal, Quebec.
Ann Intern Med. 1989 Dec 1;111(11):939-42. doi: 10.7326/0003-4819-111-11-939.
Practicing physicians are the key to effective health promotion and disease prevention in their communities, according to the Guide to Clinical Preventive Services released in May by the United States Preventive Services Task Force. The Guide focuses on the clinical practitioner and strongly advocates integrating preventive activities into clinical practice. It also shows how required interventions can be done by the physician normally responsible for ongoing care. Case-finding is emphasized as a viable and desirable strategy in early detection of disease. The report also acknowledges behavioral and lifestyle components of risk factors for disease and the physician's opportunities to promote change in patients' risky behavior. We discuss the implications of including patient education and counseling in the physician's clinical armamentarium, highlighting changes in educational and health care delivery systems that can make such interventions work in preventive programs. The soundness of a best-evidence synthesis method to formulate recommendations and the use of a priori scientific rules to determine the effectiveness of many current and proposed preventive activities are hallmarks of the task force's approach to integrating science and clinical practice.
根据美国预防服务工作组5月份发布的《临床预防服务指南》,执业医师是其所在社区有效促进健康和预防疾病的关键。该指南以临床从业者为重点,大力倡导将预防活动纳入临床实践。它还展示了负责持续护理的医生通常如何进行所需的干预措施。病例发现被强调为疾病早期检测中一种可行且可取的策略。该报告还承认疾病风险因素的行为和生活方式组成部分,以及医生促进患者改变危险行为的机会。我们讨论了将患者教育和咨询纳入医生临床手段的意义,强调了教育和医疗保健提供系统的变化,这些变化可以使此类干预措施在预防项目中发挥作用。采用最佳证据综合方法来制定建议以及使用先验科学规则来确定许多当前和提议的预防活动的有效性,是该工作组将科学与临床实践相结合方法的标志。