Primary care practitioners and health promotion: a review of current practices

Issue addressed: An increasing number of commentators have argued that medical practitioners are ideally placed in the health-care system to provide preventive care. However, few comprehensive reviews have been conducted to systematically examine the potential and extent of medical practitioner involvement in disease prevention. This paper aims to review the current published international literature in order to examine the evidence relating to the role of the primary care practitioner in disease prevention. Methods: A systematic review was conducted of descriptive studies portraying the extent of disease prevention in primary care practice in the three areas of smoking cessation, alcohol intervention, and cervical screening, utilising computerised and manual data sources. Studies published between 1991 and 1994 which met a set of methodological criteria were reviewed. A selective and non- exhaustive search of the literature was conducted to explore the potential of primary care practitioners as disease prevention agents, and barriers to their role in disease prevention. Results: The paper demonstrates that primary care practitioners hold great potential to successfully employ disease prevention strategies. However, a review of the current literature describing rates of prevention occurring in primary care indicates that the potential remains largely unrealised. The most frequently cited barriers to primary care-based disease prevention are discussed. Conclusions: The paper identifies a need for a unified approach to tackling the barriers and assisting primary care practitioners to practice preventive health care. So what? The paper demonstrates that although medical practitioners could contribute to health promotion, they are not provided with the optimal services, resources and incentives to do so. The review provides baseline information which should shape the development of strategies aimed at helping practitioners incorporate prevention into busy practice. (author abstract)