Changing office routines to enhance preventive care. The preventive GAPS approach.

While family physicians aspire to provide their patients with the best possible preventive care, the services actually provided sometimes fall short of this ideal. Enhancing the provision of preventive care may require changes in office operations. Through working with more than 200 community practices in the Cancer Prevention in Community Practice Project, we have developed the Preventive GAPS Approach, which can help physicians and their practice staff to enhance their preventive care. The approach is based on teamwork among clinicians, staff, and patients; routines that encourage opportunistic provision of indicated preventive care; and flexibility, which allows physicians and their staffs to tailor their improvement strategy and the pace of change to their own unique situation. The approach includes the following four-step method (or GAPS): goal setting regarding preventive care; assessment of existing routines that support preventive care and of the current level of attainment of preventive goals; planning to modify existing routines that support preventive care; and starting and maintaining the improved preventive care office system.