Clinical preventive services, that is, preventive medicine as it is applied to individual patients, has increased in prominence in medical care. Recommendations about aspects of screening, counseling, immunization, and chemoprophylaxis for individual patients have been made by various professional organizations, most notably the U.S. Preventive Services Task Force. The report from the Task Force supplies evidence-based assessments of the clinical efficacy of various preventive services. The Task Force provides great detail on what should be offered to individual patients and when.

What has been lacking is a comprehensive yet practical work on how to provide clinical preventive services, from techniques for the history and physical examination to techniques for counseling and practice organization. Health Promotion and Disease Prevention in Clinical Practice was written to fill this void.

The book is organized around the tenets that risk factors should be identified in asymptomatic patients and that this risk assessment should be used to tailor health maintenance plans to individual patients. After briefly summarizing basic epidemiologic and population-based principles (such as absolute versus relative risk reduction and test sensitivity and specificity versus positive and negative predictive values), the book walks the clinician through the elements of the usual patient encounter, providing clear and frequently detailed information on pertinent aspects of the history, physical examination, and laboratory-based tests to determine patient risk factors.

The major portion of the book examines approximately 17 health maintenance topics, such as tobacco use and immunizations. Chapters provide specific suggestions about testing or counseling. Individual screening assessment tools are presented for such factors as nutritional status, depression, and alcoholism. These tools are supplemented by citations of recent work in the medical literature and the presentation of sources of educational materials for both patients and professionals. Behavioral counseling techniques are described in detail. The various authors give specific instructions in communication skills for everything from history taking to discussing lifestyle modification.

The final part of the book discusses practice organization for the implementation of preventive services. Useful information is presented on developing health maintenance protocols in various practice settings. Also included are chapters on reimbursement and on how to link billing information to computerized tracking systems. The book even lists the pertinent CPT and ICD-9-CM codes.

The book's shortcomings are few and far between. Some topics, such as chemoprophylaxis, are presented only briefly. There is the occasional typographical error. While reading a given chapter, the reader must frequently refer to tables and summaries presented in other chapters. Williams & Wilkins would do the medical community a great service if it would publish this work in combination with the Task Force report in a computer-readable format with hypertext capability.

This book admirably fulfills its goal of providing information that clinicians can incorporate into day-to-day practice. One can look up specific information quickly during a busy office session or use it to plan a monitoring system for a large group practice. This book belongs in the office of every practitioner who provides preventive services.