Am Fam Physician. 2009 Jul 15;80(2):132-135.
Since 2000, the Agency for Healthcare Research and Quality (AHRQ) has partnered with American Family Physician to bring you case studies from the U.S. Preventive Services Task Force (USPSTF). This issue features a summary of the USPSTF's recommendation statement on screening for gestational diabetes mellitus, followed by a Putting Prevention into Practice (PPIP) case study, authored by AHRQ staff, that highlights important points for clinical practice.
Much has changed since we first introduced the PPIP series.1 In 2007, in response to feedback from family physicians and other clinicians, the USPSTF updated its methods for making recommendations2 and the structure of its recommendation statements.3 Changes to the recommendation statement that are reflected in this issue include a clearer assessment of the balance of benefits and harms of the preventive service; specific suggestions for practice when the evidence is insufficient; and a clinical summary of the recommendation.
In addition, AHRQ has developed several new resources and tools to make it easier for physicians to access USPSTF recommendations at the point of care. In 2005, we published the first Guide to Clinical Preventive Services, a pocket-sized handbook containing abridged versions of all current recommendations. An updated version of this guide is issued every year. Recognizing the diffusion of computers and personal digital assistants (PDAs) into clinical practice, the USPSTF released the electronic Preventive Services Selector in 2006. It is available in Web-based and PDA-compatible versions at http://www.epss.ahrq.gov. Last year, AHRQ assisted the National Health Information Center in making selected USPSTF recommendations available to patients in the interactive Web tool Myhealthfinder (http://www.healthfinder.gov). Like the ePSS, Myhealthfinder provides current information about preventive services that are applicable to a patient's age and gender.
Despite the existence of USPSTF recommendations, which have long informed and are generally consistent with the clinical policies of the American Academy of Family Physicians, there remains a wide discrepancy between what the evidence shows is effective and what actually occurs in clinical practice. Screening and counseling services of proven benefit are underused,4 whereas preventive services that provide no benefit or that cause harm are commonly offered.5
Because developing and disseminating evidence-based guidelines are only part of the battle, AHRQ has supported innovative research to find the most effective ways to implement these guidelines in primary care settings. For example, reminder systems, learning models, and focused training in methods of practice change were shown to increase colorectal cancer screening rates in diverse practice-based research networks.6
Family physicians have long cited the lack of insurance coverage for certain preventive services as an obstacle to providing them. Although a positive USPSTF recommendation does not guarantee coverage for that service, private insurance purchasers are increasingly acknowledging the USPSTF as an essential resource in designing health care plans that are most likely to benefit their employees.7 Recent legislation will also make it easier for Medicare to pay for additional “reasonable and necessary” preventive services that have received a USPSTF recommendation grade of A or B.
The climate for preventive medicine is increasingly positive. We hope that by providing up-to-date recommendations on screening, counseling, and preventive medications, this series of articles will make it easier for you to do a better job of putting prevention into your practice.
Address correspondence to Kenneth W. Lin, MD, at firstname.lastname@example.org. Reprints are not available from the author.
Author disclosure: Nothing to disclose.
1. Kamerow DB. Evidence-based preventive care: a timely matter [editorial]. Am Fam Physician. 2000;61(7):19841986–1987.
2. Guirguis-Blake J, Calonge N, Miller T, Siu A, Teutsch S, Whitlock E. Current processes of the U.S. Preventive Services Task Force: refining evidence-based recommendation development. Ann Intern Med. 2007;147(2):117–122.
3. Barton MB, Miller T, Wolff T, et al. How to read the new recommendation statement: methods update from the U.S. Preventive Services Task Force. Ann Intern Med. 2007;147(2):123–127.
4. McGlynn EA, Asch SM, Adams SJ, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–2645.
5. Merenstein D, Daumit GL, Powe NR. Use and costs of nonrecommended tests during routine preventive health exams. Am J Prev Med. 2006;30(6):521–527.
6. Klabunde CN, Lanier D, Meissner HI, Breslau ES, Brown ML. Improving colorectal cancer screening through research in primary care settings. Med Care. 2008;46(9 suppl 1):S1–S4.
7. Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, eds. A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006. http://www.businessgrouphealth.org/benefitstopics/topics/purchasers/index.cfm. Accessed April 29, 2009.
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