Towards achieving the full potential of primary care in cancer prevention. Free

ED02-02

Background: Primary care plays a central role in promoting cancer prevention to the public but has not achieved its full potential in this regard. This talk will describe the current status of primary care cancer prevention service and science then explore approaches that could help primary care achieve its full potential in cancer prevention and screening. Current status: Most people see their primary care clinician several times a year and many rely on primary care for screening and behavior advice. However, when those who are not up-to-date for cancer screening are asked why, the most common reply is, "my doctor didn't recommend it." Recent studies such as the NCI supported Direct Observation of Primary Care Project have enriched our understanding of the processes by which cancer preventive services are provided in primary care. Primary care clinicians face competing demands, conflicting guidelines, and lack systems that support provision of preventive services. The evidence base on what works for behavioral counseling is especially weak. Appropriate models and tools to support delivery of first-rate cancer prevention care are being developed. New laboratories for study called Practice Based Research Networks are in place but widespread adoption lags. Evidence from high quality resources, such as Put Prevention into Practice, CancerPlanet, and recommendations of the US Preventive Services Task Force, are readily available but seldom consulted or applied. Towards achieving the full potential of primary care: Ongoing projects will be described that are instructive on how to reorganize primary care practice internally to promote high quality cancer prevention care. Others projects have identified external resources such as care management that can support cancer screening working in parallel with primary care and integrated with it. In addition to the growing evidence base about effective processes of providing cancer prevention services in primary care, new projects are addressing the process of change. The jump from the guideline page to the community practice has been a long one. Lectures, articles and web resources are not enough to make the jump but quality improvement infrastructures and other external supports can. Current attention to HEDIS measures and Pay for Performance are being informed by policy reforms in the United Kingdom that reward primary care clinicians for evidence based care, including care prevention services. Conclusion: The evidence is emerging that can be used to assure that primary care achieves its potential in cancer prevention. Medical groups, health plans, and policy makers will need to support evidence based change processes for practices that lead to evidence based care processes in the examination room and in the lives of patients.