Preventive Medicine Partners With Medscape
I am pleased to launch the first of many Medscape columns to come on the subject of preventive medicine. The writers will be members and fellows from the American College of Preventive Medicine (ACPM), a national medical specialty founded in 1954. ACPM actively promotes the practice, teaching, and research agenda of preventive medicine. ACPM's members are committed to preventing disease and promoting the health of the individual, the community, and the nation.

ACPM's members, who specialize in occupational medicine, general preventive medicine/public health, or aerospace medicine, hold clinical, research, teaching, administrative, and leadership positions in public agencies, managed care organizations, industry, the military, and academia. ACPM works closely with many governmental and nongovernmental agencies to strengthen the practice of preventive medicine, including the Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ), the Health Resources and Services Administration (HRSA), and the National Institutes of Health (NIH).

Preventive medicine is becoming more and more prominent. Never has there been more attention by the public, the media, government, health professionals, and health plans focused on prevention. My main complaint is that too many people are still saying "preventative medicine." Please help me to educate the world that the extra "ta," although in the dictionary as an alternate spelling, is not needed.

The Internet has become an exciting means of informing consumers, clinicians, and others about prevention, self care, and evidence-based tools such as the Guides to Clinical and Community Preventive Services (see Resources section below). Prevention and self-care books, magazines, and newsletters continue to sell well and enjoy large readerships.

National organizations such as the American Cancer Society and the American Heart Association, although often devoted to a single disease or system, are also promoting preventive medicine in a big way. National measures, standards, and goals such as Healthy People 2010 and the Health Employer Data and Information Set (see Resources section below) have focused enormous attention on preventive medicine. What gets measured gets managed, so metrics such as immunization and mammography rates are often in the news.

The Partnership for Prevention (see Resources section below) has produced groundbreaking, widely acclaimed studies about evidence-based priorities in preventive services and policy interventions. Even cure-oriented subspecialists are beginning to appreciate the value of prevention, spurred on by the tertiary prevention practiced in disease-management programs.

Let's have some fun and look ahead to the year 2010 at "A day in the life of Dr. I. M. Wired"...

She's board-certified in family and preventive medicine. The latter credential came from a part-time master's of public health and preventive medicine residency that included rotations in a local health department, health plan, biotechnology start-up, and employer health promotion program. She works part of her time in a totally automated group practice, including an electronic health record, which is available to each patient via a secure Internet II Web site. The automation was subsidized by fee bonuses from all payers. Her first 4 hours of the day are spent on email, phone, and interactive TV with patients and other health professionals. Her patients all have access to telephone triage and Internet health information. All of the services are reimbursable by third-party payers. Her next 2 hours are spent seeing patients. The electronic health record is always available on her wireless personal digital assistant, which also has the latest evidence-based practice guidelines and medication lists, and can transmit electronic prescriptions and other orders. All patients are prescreened, have completed an annual health risk appraisal, are counseled about self-care, and are followed up with other professionals, whose services are also reimbursed by all payers. Her last 2 hours of the workday are spent working with teams on community prevention projects sponsored by her specialty society (ACPM) and a coalition of health plans, hospitals, government agencies, universities, employers, nonprofit organizations, etc. Her free time after work is spent working out at a community facility with her family. The interesting thing is that all of Dr. Wired's activities are in practice somewhere in the United States today. The problem is that they're not very prevalent.

So here is my bigger vision for the year 2010:

The consumer is the most important part of the health system. Everything else is there to serve the needs of the person and the family. Preventive medicine is one of the fastest-growing and most popular medical specialties in the United States. Preventive medicine specialists are on the cutting edge of new trends, including biotechnology, genomics, disease management, quality improvement, health informatics, e-Health, pharmacoepidemiology, health services research, and health systems reform. All US residents have health insurance and access to quality healthcare that focuses on health promotion. Physicians spend at least one third of their working time on primary, secondary, and tertiary preventive care, most of it with teams of other health professionals. At least one third of the NIH research budget is devoted to primary and secondary prevention research, much of it at the new National Institute for Health Promotion. Meanwhile, the prevention research and demonstration budgets at AHRQ, CDC, and HRSA have grown as fast as the NIH budget. Health plans, employers, government, and consumers spend at least one third of their health dollars on clinical and community preventive services, including health promotion, and use of evidence-based guidelines. Most of the Healthy People 2010 objectives have been achieved.

Accomplishing these goals will require a lot of new thinking and a willingness to change. And I don't mean change as reflected by Dilbert's quote. He said, "Change is good. You go first!"

With the renewed dedication and commitment of you -- Medscape's dedicated readers -- this vision can become reality. Thanks in advance for the opportunity to share important, timely prevention information with you in our new monthly column.

Guides to Clinical and Community Preventive Services

Health Employer Data and Information Set

Partnership for Prevention