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PRESIDENT’S
MESSAGE

Preventative Medicine in 2022 –

A Renewed Push

By Rajeev Suri, MD, MBA, FACR, 2022 BCMS President

Preventative (or Preventive) medicine are terms that have been used in- and their providers. Any immuniza-
terchangeably since the 17th century and consist of measures taken for tions or preventive procedures can be
disease and disability prevention to ultimately improve disease outcomes. scheduled at community-based clinics
Each year, millions of people die of preventable deaths which are more through patient navigators, thus aiming to close the gaps that adversely
often due to preventable behaviors (lifestyle choices) and exposures (en- affected underserved patients and populations living in medical deserts.
vironmental factors and disease agents). Leading causes of preventable These programs may not eliminate the social determinants of health such
deaths include chronic cardiovascular and respiratory disease and diabetes, as poverty and food insecurity, but could make access to the preventive
while others include cancer, unintentional injuries and infectious diseases. services more equitable.
We know the value of preventing disease; however, we live in a time In Bexar County, San Antonio Metro Health is leading the charge with
when our knowledge and actions don’t always match up. In fact, our the ‘SA Forward Plan’ to improve the health of our community. The
knowledge of the value of preventing disease and disability far exceeds our strategic plan over the next five years plans to invest in preventive care and
investments in public education and public health infrastructure that focus on six priority areas: Access to Care; Data and Technology Infra-
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could support our taking advantage of that knowledge. The COVID-19 structure; Food Insecurity and Nutrition; Health Equity and Social Jus-
pandemic has exposed inadequacies of the current healthcare system, and tice; Mental Health and Community Resilience; and Violence
as the US healthcare system defines the new normal in the evolving post Prevention. Further investments to promote comprehensive population
COVID-19 era, it needs a new approach to providing sustainable preven- health objectives that support preventive care are coming via the planned
tive care for our populations. Failure to do so will worsen the long-standing Public Health Division within University Health created in partnership
disparities in health care that have been underscored by the pandemic. with Bexar County.
Preventive care has traditionally focused on face-to-face annual exams Nationally, however, challenges still exist to implementing this para-
and labs/tests. This low-efficiency and low-efficacy model suffered during digm shift in preventive healthcare to a population-based strategy. These
the pandemic due to decreased overall in-person patient visits, and dis- include payment reform for evidence-based preventive care delivery with
parities in race, ethnicity and socioeconomic status among those who uti- demonstrable commitment to addressing disparities. The reform is needed
lized these in-person visits. The US healthcare system could shift the focus not only for providers but also for community-based preventive healthcare
of preventive case from face-to-face exams to a strategy that focuses on delivery systems. Patient and clinician acceptance is a major hurdle, but a
population health: clinical registries to identify preventive services needed, bigger hurdle is the acceptance from the overall healthcare system. A major
annual prevention kits to facilitate widespread home-based testing, shared challenge is federal and state level funding. Rather than increasing the
decision making, self-scheduling of screening tests and procedures at ap- growing health debt, what is needed is a change in focus of healthcare in-
proachable community settings, and community-based strategies with vestments to prevention and health promotion.
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navigators to overcome health disparities in underserved populations. A large-scale shift in population-based prevention strategy is long
Robust comprehensive registries that track all USPTF (US Preventive overdue. Maybe the uncovering of the chronic pandemic by the recent
Services Task Force) grade A and B preventive services for patient popu- acute pandemic/crisis will be the much-needed impetus that can drive
lations are urgently needed to track the current versus targeted status. In- this change.
tegration of such registries with EHRs (electronic health records) to
improve patient communication, and interoperability of these smart reg- References
istries across EHRs and diverse health settings is key to analyzing utiliza- 1. Hoffman D. Commentary on Chronic Disease Prevention in 2022.
tion population patterns and health conditions by linking patients and https://chronicdisease.org/wp-content/uploads/2022/04/
clinicians to achieve the best prevention methods. FS_ChronicDiseaseCommentary2022FINAL.pdf
Targeted annual prevention kits for addressing the USPTF grade A and 2. Horn DM, Haas JS. COVID-19 and the mandate to redefine preven-
B preventive services would be needed for every patient to allow POC tive care. NEJM 2020; 383; 1505-1507
(point-of-care) at-home testing along with easily-accessible questionnaires
to facilitate personalized risk assessment and shared decision-making for Rajeev Suri, MD, MBA, FACR is the 2022 President of the Bexar
chronic conditions. The pandemic has confirmed to us that virtual en- County Medical Society, Tenured Professor and Interim Chair of the De-
counters with primary care providers (PCPs) work, and self-scheduled partment Radiology at UT Health San Antonio, and Chief of Staff at Uni-
visits with PCPs can facilitate shared decision-making between patients versity Hospital San Antonio.

8 SAN ANTONIO MEDICINE • June 2022