Put Prevention Into PracticePut Prevention Into Practice

Understand the PPIP ProgramUnderstand the PPIP Program

What is What is Put Prevention Into PracticePut Prevention Into Practice (PPIP) (PPIP)?? Why is PPIP needed?Why is PPIP needed? How was PPIP developed?How was PPIP developed? Who uses PPIP?Who uses PPIP? New resource: New resource: A Step-by-Step Guide to Delivering A Step-by-Step Guide to Delivering

Clinical Preventive Services: A Systems ApproachClinical Preventive Services: A Systems Approach

Healthy People 2010

Guide to ClinicalPreventive Services

Priorities for Prevention

Put Prevention

Into Practice

What is PPIP?What is PPIP?

What is PPIP?What is PPIP?

Implementation program derived from Implementation program derived from recommendations of USPSTFrecommendations of USPSTF

Purpose:Purpose:– Increase awareness of preventionIncrease awareness of prevention– Increase appropriate use of clinical preventive Increase appropriate use of clinical preventive

services (screening tests, counseling, immunizations)services (screening tests, counseling, immunizations)

Why is PPIP Needed?Why is PPIP Needed?

Vast majority of premature death is preventableVast majority of premature death is preventable Strong evidence shows that clinical preventive Strong evidence shows that clinical preventive

services can prevent some of the leading causes of services can prevent some of the leading causes of deathdeath

Combat barriers to the effective delivery of Combat barriers to the effective delivery of preventive carepreventive care

How Was PPIP Developed?How Was PPIP Developed?

Launched in 1994 to increase implementation Launched in 1994 to increase implementation of USPSTF recommendationsof USPSTF recommendations

Management transferred to AHRQ in 1998Management transferred to AHRQ in 1998

Cooperation of many public and private Cooperation of many public and private groupsgroups

How Was PPIP Developed?How Was PPIP Developed?

Based on research-tested interventions for Based on research-tested interventions for improving delivery of preventive services in primary improving delivery of preventive services in primary care settingscare settings

Focus group tested with clinicians, office staff, Focus group tested with clinicians, office staff, patientspatients

Ongoing consultation with users and potential usersOngoing consultation with users and potential users

PPIP MessagesPPIP Messages

Clinical prevention works and is importantClinical prevention works and is important

Different people need different servicesDifferent people need different services

PPIP provides tools and resources for clinicians and PPIP provides tools and resources for clinicians and their patients to provide comprehensive preventive caretheir patients to provide comprehensive preventive care

A system is needed to ensure that prevention is a A system is needed to ensure that prevention is a routine part of every patient encounterroutine part of every patient encounter

Barriers to Delivering Barriers to Delivering Clinical Preventive ServicesClinical Preventive Services

Patient barriersPatient barriers

– Lack of knowledge Lack of knowledge – Anxiety about procedures and resultsAnxiety about procedures and results– Inconvenience Inconvenience – CostsCosts

Barriers to Delivering Clinical Barriers to Delivering Clinical Preventive ServicesPreventive Services

Clinician barriers: Clinician barriers: – Lack of prevention training and knowledgeLack of prevention training and knowledge– Lack of confidence that prevention makes a Lack of confidence that prevention makes a

difference difference – Lack of time Lack of time – Inadequate reimbursementInadequate reimbursement

Barriers to Delivering Clinical Barriers to Delivering Clinical Preventive ServicesPreventive Services

Office barriers:Office barriers: – Lack of knowledge Lack of knowledge – Lack of motivation, not ready for change Lack of motivation, not ready for change – Lack of effective teamworkLack of effective teamwork– Clinical setting focused on illness and treatment rather than Clinical setting focused on illness and treatment rather than

wellness and prevention wellness and prevention – Inadequate systems for delivery, tracking, and followup for Inadequate systems for delivery, tracking, and followup for

preventive servicespreventive services

What Can PPIP Do?What Can PPIP Do?

Educate providers, office staff, and patients about which Educate providers, office staff, and patients about which services should be delivered:services should be delivered:– Counseling for risk reduction (smoking cessation)Counseling for risk reduction (smoking cessation)– Screening tests for early detection of disease (Pap smears)Screening tests for early detection of disease (Pap smears)– Immunizations for primary prevention (measles, vaccination)Immunizations for primary prevention (measles, vaccination)– Chemoprevention (aspirin to prevent heart disease)Chemoprevention (aspirin to prevent heart disease)

What Can PPIP Do?What Can PPIP Do?

Provide a systematic approach for Provide a systematic approach for delivering clinical preventive servicesdelivering clinical preventive services

Help providers and patients track Help providers and patients track preventive carepreventive care

Who Uses PPIP?Who Uses PPIP? Primary care practicesPrimary care practices Health plansHealth plans Employers and purchasers of careEmployers and purchasers of care Advocacy groupsAdvocacy groups Federal agenciesFederal agencies Professional organizationsProfessional organizations Medical/nursing studentsMedical/nursing students Health departmentsHealth departments HospitalsHospitals

Who Uses PPIP? Who Uses PPIP?

Health Professions:Health Professions: Family practice and preventive medicine residenciesFamily practice and preventive medicine residencies Physicians assistant programsPhysicians assistant programs Nursing programsNursing programs Medical schoolsMedical schools Continuing educationContinuing education

PPIP Materials, PPIP Materials, Tools and ResourcesTools and Resources

For patients and othersFor patients and others– Personal Personal andand Child Health Guides Child Health Guides– Staying Healthy at 50+Staying Healthy at 50+– Fact sheets: Fact sheets: What’s New from the U.S What’s New from the U.S

Preventive Services Task ForcePreventive Services Task Force

PPIP Materials, PPIP Materials, Tools, and ResourcesTools, and Resources

For providers and officesFor providers and offices– Task Force recommendations (previous and Task Force recommendations (previous and

current)current)– Clinician’s HandbookClinician’s Handbook– A Step-by-Step Guide to Delivering Clinical A Step-by-Step Guide to Delivering Clinical

Preventive Services: A Systems ApproachPreventive Services: A Systems Approach

A Step-by-Step Guide to Delivering A Step-by-Step Guide to Delivering Clinical Preventive Services: A Clinical Preventive Services: A

Systems ApproachSystems Approach

Explains how to deliver routine Explains how to deliver routine preventive care to every patientpreventive care to every patient

Tells what services to provideTells what services to provide

Describes how to involve all staffDescribes how to involve all staff

Explains how to evaluate and Explains how to evaluate and refine your systemrefine your system

Why Use Why Use A Step-by-Step Guide to A Step-by-Step Guide to Delivering Clinical Preventive Services?Delivering Clinical Preventive Services?

Breaks delivering preventive services into small, Breaks delivering preventive services into small, manageable stepsmanageable steps

Can be adapted to your settingCan be adapted to your setting

Includes worksheets, flow sheets, and health risk profiles to Includes worksheets, flow sheets, and health risk profiles to use “as is” or customizeuse “as is” or customize

Based on scientific evidenceBased on scientific evidence

How theHow the Guide Guide is Organized is Organized 6 chapters; 3 appendixes6 chapters; 3 appendixes Chapter 1:Chapter 1: Assess your readiness for a systems change Assess your readiness for a systems change

– Assess staff values and beliefsAssess staff values and beliefs– Elicit patient opinionElicit patient opinion– Introduce PPIP as a possibilityIntroduce PPIP as a possibility

Chapter 2:Chapter 2: Assess your current prevention practice Assess your current prevention practice– Assess current preventive services, individual and group systems, Assess current preventive services, individual and group systems,

and clinical flowand clinical flow

How the How the GuideGuide is Organized is Organized

Chapter 3:Chapter 3: Develop a preventive care protocol Develop a preventive care protocol– Establish preventive care standardsEstablish preventive care standards– Conduct chart auditsConduct chart audits– Establish goals for your settingEstablish goals for your setting– Design an evaluation processDesign an evaluation process

Chapter 4:Chapter 4: Establish a process for delivering preventive care Establish a process for delivering preventive care– Obtain staff and administrative supportObtain staff and administrative support– Assign responsibilitiesAssign responsibilities– Determine information and materials flowDetermine information and materials flow

How theHow the Guide Guide is Organized is Organized

Chapter 5:Chapter 5: Evaluate your PPIP system Evaluate your PPIP system Chapter 6:Chapter 6: Incorporate prevention materials Incorporate prevention materials AppendixesAppendixes

– Presentation materialsPresentation materials– WorksheetsWorksheets– Health risk profiles and flow sheetsHealth risk profiles and flow sheets– Prevention prescriptionsPrevention prescriptions

Support and InformationSupport and Information

E-mail: PPIP@ahrq.gov E-mail: PPIP@ahrq.gov

– Telephone or e-mail supportTelephone or e-mail support

– On-site consultationOn-site consultation

AHRQ Clearinghouse: AHRQ Clearinghouse:

– 800-358-9295 or ahrqpubs@ahrq.gov800-358-9295 or ahrqpubs@ahrq.gov

AHRQ Web site: AHRQ Web site:

– www.ahrq.gov/clinic/ppipix/htmwww.ahrq.gov/clinic/ppipix/htm