Anticipatory care and the role of Dutch general practice in health promotion--a critical reflection.

The Dutch GP is in a unique (potential) position within the health care system with regard to clinical health promotion. An essential feature is the integration in the regular consultation. The concept of anticipatory care seems fit to understand this integration. Because of the GP's (anticipatory) knowledge of the patient's medical history, lifestyle, risk factors, living conditions, health perceptions and family context, he has the opportunity to include during the consultation, aspects of health promotion and disease prevention. The production of evidence-based guidelines by the Dutch College of General Practitioners greatly enhances the integration of health promotion within the consultation. Strategies for the implementation are needed on three different levels: encouragement of the patient to ask questions, training of the GP and organization of the practice. An important aspect of the last strategy concerns systematic delegation of health promotion tasks, usually related to the guidelines, to the practice assistant or practice nurse. Recent legislation in the Netherlands underlines and advances the above mentioned trends.