Circle the number that best indicates the extent to which you agree or disagree with each statement.
(1 = Very much; 7 = Not at all)
1. Prevention is an important aspect of the care we provide in this practice.
1 2 3 4 5 6 7
2. We think prevention should be more strongly emphasized in our practice.
1 2 3 4 5 6 7
3. Someone in our practice has the vision, leadership, and authority to make prevention happen here.
1 2 3 4 5 6 7
4. We have adequate time to do one-on-one patient education or patient counseling.
1 2 3 4 5 6 7
5. Nurses in our practice regard patient education as one of their main tasks.
1 2 3 4 5 6 7
6. Physicians in our practice regard patient education as one of their main tasks.
1 2 3 4 5 6 7
7. Our practice is willing to allocate resources (time, training, personnel, and space) to implement a comprehensive program to deliver clinical preventive services.
1 2 3 4 5 6 7
8. Internal communication is strong among staff and physicians in our practice.
1 2 3 4 5 6 7
9. A sense of teamwork exists among staff members and physicians in our practice.
1 2 3 4 5 6 7
10. Our practice has already implemented, or has tried to implement, specific programs for prevention (e.g., cancer prevention programs, smoking cessation, and diabetes education).
1 2 3 4 5 6 7
11. Our practice has effective referral mechanisms for patients to receive any screening tests not provided in our office (e.g., mammography and lab).
1 2 3 4 5 6 7
12. We have effective referral mechanisms for patients to receive behavior change counseling.
1 2 3 4 5 6 7
13. We follow up on patients referred to other services (e.g., record test results on charts).
1 2 3 4 5 6 7
14. We can allow adequate planning time to incorporate prevention into our practice.
1 2 3 4 5 6 7
15. We have a quality assurance system in place to assess and improve service delivery (e.g., Continuous Quality Improvement [CQI]; Total Quality Management [TQMI]).
1 2 3 4 5 6 7
16. We have a system in place to report the percentage of eligible patients who are receiving the screening tests they need (e.g., Pap smears and immunizations).
1 2 3 4 5 6 7
Source: Readiness to put prevention in your practice. Texas Medicine 92(12):35,1996.