Health maintenance in clinical practice: strategies and barriers.

Obstacles to the implementation of preventive services in clinical practice include barriers raised by patients, physicians and the health care delivery system itself. Physicians may overcome these barriers to a great extent by improving their time management skills, practice organization system and reinforcement mechanisms. For clinical prevention to be successfully initiated and maintained in practice: (1) the program must be simple and include only procedures the providers believe are worthwhile; (2) an organized record system should be used; (3) a system of checks and reinforcements for prevention must be instituted in the practice routine, and (4) adequate time for preventive services must be allocated, either by using paramedical personnel or by restricting the practice size.