title: An office systems approach to cancer prevention in primary care.
abstract: OBJECTIVE
  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.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Community and Family Medicine, Norris Cotton Comprehensive Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03755, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Dietrich
authors.forename: P A
authors.initials: PA
authors.lastname: Carney
authors.forename: C W
authors.initials: CW
authors.lastname: Winchell
authors.forename: C H
authors.initials: CH
authors.lastname: Sox
authors.forename: S C
authors.initials: SC
authors.lastname: Reed
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000517:prevention & control*; D009817:Office Management; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration*