Table 1 Barriers to Implementation of Preventive Services

Patient

   Lack of knowledge and motivation

   Lack of access to care

   Cultural factors

   Social factors

Physician

   Problem-based focus

   Feedback on prevention is native or neutral

   Time constraints

   Lack of incentives, including reimbursement

   Lack of training

Poor knowledge of benefits

Perceived ineffectiveness

Lack of skills

   Lack of specialist-generalist communication

   Lack of perceived legitimacy

Health care settings (hospitals, practices, etc)

   Acute care priority

   Lack of resources and facilities

   Lack of systems for preventive services

   Time and economic constraints

   Poor communication between specialty and primary care providers

   Lack of policies and standards

Community/society

   Lack of policies and standards

   Lack of reimbursement