Dietrich A J, Woodruff C B, Carney P A
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH.
Arch Fam Med. 1994 Feb;3(2):176-83. doi: 10.1001/archfami.3.2.176.
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.
虽然家庭医生渴望为患者提供尽可能最佳的预防保健服务，但实际提供的服务有时却未达到这一理想状态。加强预防保健服务的提供可能需要改变诊所运营方式。通过在社区实践癌症预防项目中与200多个社区诊所合作，我们开发了预防差距方法（Preventive GAPS Approach），该方法可帮助医生及其诊所工作人员加强预防保健服务。该方法基于临床医生、工作人员和患者之间的团队合作；鼓励适时提供指定预防保健服务的常规做法；以及灵活性，这使医生及其工作人员能够根据自身独特情况调整改进策略和变革节奏。该方法包括以下四个步骤（或差距）：设定预防保健目标；评估支持预防保健的现有常规做法以及预防目标的当前达成水平；计划修改支持预防保健的现有常规做法；启动并维持改进后的预防保健诊所系统。
