Health Promotion and Disease Prevention in Clinical Practice.

Health Promotion and Disease Prevention in Clinical Practice. – book reviews

Seth Foldy

Edited by Steven H. Woolf, M.D., M.PH., Steven Jonas, M.D., M.P.H., Robert S. Lawrence, M.D. Pp. 618. Price, $34. Williams & Wilkins, 351 W. Camden St., Baltimore, MD 21202-2436,1996.

The first U.S. Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services set a benchmark for clinic-based prevention and health promotion that, for the first time, achieved widespread support from third-party payers, skeptical physicians and the public alike. Setting such a benchmark for which services should be provided has accelerated research into how health care providers can achieve the greatest success and consistency in their prevention activities. This research, tempered with a healthy dose of real-life clinical experience, has been collected in Health Promotion and Disease Prevention in Clinical Practice, a concise “how-to” guide published simultaneously with the second Task Force report. The book is a successful companion to the USPSTF Guide. Not coincidentally, its editors and authors include several Task Force members and staff.

The book thoughtfully integrates clinical prevention into the routine process of clinical care. Minor alterations in the typical history and physical examination help identify patient-specific risk factors for preventive attention. The physical examination provides “teachable moments” for several simple preventive discussions. A series of concise chapters then review effective techniques for helping patients with tobacco use, exercise, nutrition, injury prevention, weight management, immunization, sexually transmitted diseases, cognitive impairment and other topics. Although much of the material will be familiar to experienced practitioners, some chapters integrate very recent research (such as the role of resting metabolic rate in weight-loss efforts) into practical strategies for the primary care clinician. These chapters emphasize what works in the office, not in the behavior research laboratory, are well referenced and include sources for recommended patient education materials. They provide a valuable “one-stop” compendium for the busy physician.

Just because clinicians know what to do doesn’t mean they’ll do it. This book also includes chapters on the features of office practice that enable and reinforce the practitioner’s good intentions. These chapters include pithy, wisdom-laden discussions of clinic health maintenance schedules and computer aids, an inspiring and useful model for practice redesign from the Group Health Cooperative of Puget Sound and even an intelligible chapter on reimbursement.

Excellent discussions of the principles of risk assessment, methods of influencing health behavior, follow-up of abnormal laboratory results, ethics and the role of public health departments, work-site health promotion and emergency departments round out the book nicely.

The authors respect patient autonomy and emphasize partnership, not paternalism or victim-blaming. The book is readable, logically organized and extensively cross-indexed. The reader can sense the intelligent presence of the editors at every turn of the page. Things are, frankly, where you would expect to find them.

Anyone can quibble with a survey so broad yet compact. Although the editors explicitly exclude discussion of prevention for pregnant women, this exclusion is overdone; for example, there is no mention of the utility of human immunodeficiency virus (HIV) testing in pregnancy during a general discussion of HIV screening. A future edition would be strengthened by the inclusion of a chapter on health promotion across cultures. This text barely mentions the family history (e.g., genetic and family-systems aspects) as important information to be integrated into a person’s health-risk profile. The latter topic begs for an intelligent, practical chapter, which I’ve yet to see anywhere. Don’t wait for the second edition, though. Read this book, implement its many valuable suggestions and keep it next to the USPSTF Guide for frequent reference.

COPYRIGHT 1996 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group