Barriers to preventive interventions for coronary heart disease.

Many barriers exist to the delivery of preventive services by cardiologists and other physicians. Appropriate training and the development of supportive infrastructures can effectively overcome these barriers. In addition, institutional priorities must change to encourage such efforts. Cardiologists must continue to recognize the importance of risk-factor modification, and training programs in cardiology should teach appropriate counseling techniques, the use of risk-factor-lowering pharmacologic agents, and the manner in which cardiologists should interface with dietitians and other ancillary personnel [77]. In addition, it is important to recognize and teach, both didactically and by example, that counseling patients and carrying out long-term preventive interventions can be as gratifying and interesting as performing dramatic procedures that, although valuable and rewarding, take place at a very late point in the patient's clinical course, a point that might have been averted by greater attention to risk-factor modification. Increasingly, the public and governmental agencies are becoming involved in encouraging such an approach [66], and health care provider groups [78] and organizations [67] are also facilitating the development of a more comprehensive approach to the delivery of preventive intervention [79].