1. Novick, Lloyd F. MD, MPH, Editor

Article Content

Three articles in this issue of JPHMP focus on the implementation of "Put Prevention Into Practice" (PPIP) program in Texas. As the articles describe, PPIP is a national initiative to bolster the delivery of clinical preventive services based on the evidence-based findings of the U.S. Preventive Services Task Force (USPSTF). PPIP provides guidelines and tools for both primary and secondary prevention. Readers of this issue will benefit from the eight years of experience and research outlined by the teams from both the Texas Department of Health and the niversity of Texas who have authored this series of articles.


PPIP was developed in 1994 by the U.S. Public Health Services' Office of Disease Prevention and Health Promotion (OPHP), with the goal of improving the delivery of appropriate clinical preventive services. PPIP materials are derived from evidence-based recommendations of the U.S. Preventive Services Task Force. In 1998, management of the project was transferred within the Department of Health and Human Services to the Agency for Health Research and Quality (AHRQ). PPIP is now a component of the AHRQ program in clinical prevention.


Practitioners in public health may previously have used the text associated with "Put Prevention Into Practice," which was published by OPHP in 1998 (Clinician's Handbook of Preventive Services, 2nd edition). This volume has a series of chapters on screening, immunization/prophylaxis, children, and counseling for children, adolescents, and adults. The concepts of prevention are used in the prioritization of preventive strategies. These include the frequency and severity of the health condition, magnitude of the risk associated with specific risk factors, the characteristics of available screening tests and the feasibility and effectiveness of potential interventions. More recent updates on PPIP tools and material are available online (


The objectives of PPIP are to make tools available and reduce barriers to facilitate the delivery of clinical preventive services. Clinician barriers include lack of skills, orientation, and training in preventive services, coupled with inadequate reimbursement for preventive interventions. Office barriers include clinical settings focused on illness and unsatisfactory systems for monitoring the delivery and follow-up of preventive services. Patient barriers are related to inadequate information, motivation, and lack of insurance coverage for preventive services. Materials and guidance are available from PPIP to address these issues and to improve the delivery of preventive services in primary care settings.


A companion to the USPSTF recommendations and the tools of PPIP is the work of the independent Task Force on Community Preventive Services. Their focus is on evidence-based population health interventions. The work and progress of this task force was described in an article appearing in the November-December 2003 issue of JPHMP (9:6): "Getting People to Want Sliced Bread-An Update on Dissemination of the Guide to Community Preventive Services," authored by Bradford Myers.


Both clinical and population-based prevention are essential armaments and should be constant companions of the public health practitioner. Both PPIP and the soon-to-be published Community Guide have the potential to be outstanding resources. These initiatives must be priorities of the Department of Health and Human Services and receive funding support. A key issue with both of these initiatives is the success of their dissemination to public health professionals and related disciplines concerned with improving preventive services to individuals and communities. To date, awareness of these initiatives in the community of public health workers does not match their substantial promise for improving our practice. The Texas PPIP program, described in this issue, documents the benefits and pitfalls of this approach and is an outstanding example of the power of this model.