Dietrich A J, Carney P A, Winchell C W, Sox C H, Reed S C
Department of Community and Family Medicine, Norris Cotton Comprehensive Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03755, USA.
Cancer Pract. 1997 Nov-Dec;5(6):375-81.
The provision of preventive services holds a central place in primary care. Achievement of prevention standards offers a challenge. The authors address the efficacy of an office systems approach to improving cancer prevention and early detection services, provide a guide to assessing the appropriateness of office systems dissemination in practices targeted for improvement, and describe the range of dissemination strategies available.
Preventive service office systems depend on establishing practice routines, using tools such as flow sheets, and sharing responsibilities among practice clinicians, staff, and patients. Systems have been shown to be efficacious in a variety of settings. Computers provide a significant enhancement to paper-based tools. Some practices develop office systems themselves, whereas others require external support. Before attempting to disseminate preventive services offices systems, disseminators should ensure that adequate assistance can be provided, that assistance follows a format that is acceptable to target practices, and that target practices are receptive to assistance and able to cooperate. Dissemination strategies include journal articles, continuing education programs, manuals and tool kits, facilitation, and academic detailing. The relative expense and efficacy of these approaches require further assessment.
Office systems hold promise in enhancing provision of cancer prevention services in primary care. The practice should be approached as a team, and should include practice clinicians as well as nonclinical staff members. Current research should provide answers over the next few years about the cost-effectiveness of various approaches and the most feasible ways to promote dissemination to practices that need it.
预防服务在初级保健中占据核心地位。达到预防标准是一项挑战。作者探讨了一种办公系统方法在改善癌症预防和早期检测服务方面的效果，提供了一份指南以评估在目标改善实践中办公系统传播的适宜性，并描述了可用的传播策略范围。
预防服务办公系统依赖于建立实践常规，使用诸如流程图等工具，并在实践临床医生、工作人员和患者之间分担责任。系统已被证明在各种环境中都是有效的。计算机极大地增强了纸质工具。一些实践自行开发办公系统，而其他实践则需要外部支持。在尝试传播预防服务办公系统之前，传播者应确保能够提供充分的援助，援助遵循目标实践可接受的形式，并且目标实践愿意接受援助并能够合作。传播策略包括期刊文章、继续教育项目、手册和工具包、促进以及学术详述。这些方法的相对成本和效果需要进一步评估。
办公系统有望增强初级保健中癌症预防服务的提供。实践应作为一个团队来开展，应包括实践临床医生以及非临床工作人员。当前的研究应在未来几年提供有关各种方法的成本效益以及向有需要的实践推广传播的最可行方式的答案。
