Many of the people with whom we spoke, especially those involved in hospital-based medicine, argued that we need to better integrate prevention into primary care. Increasing access to primary care, rather than disease-specific interventions, is potentially a more effective, and cost-effective, strategy. However, primary care professionals need to increase their focus on prevention as well— risk stratification and prediabetes screening will be most effective and widespread if they are better integrated into the primary care models that so many people already access. Primary care is currently limited by a lack of both time and incentives to engage in prevention. Part of the necessary change involves improving medical education to be more aware of obesity, prediabetes, and diabetes more generally. For example, Jessica Dong, a medical student at the University of Pennsylvania who has been active in trying to modernize medical school curricula, said that clinicians need increased training in how to avoid stigmatizing patients when addressing topics like obesity and lifestyle change. Part of the necessary change also involves enabling primary care providers to devote time to prevention, and to be reimbursed for doing so.
