Introduction to AAFP Summary of Recommendations for Clinical Preventive Services

The AAFP Summary of Recommendations for Clinical Preventive Services (RCPS) is a document that is periodically updated through the work of the AAFP’s Commission on Health of the Public and Science (CHPS) and is approved by the AAFP Board of Directors. The starting point for the recommendations is the rigorous analysis of scientific knowledge available as presented by the United States Preventive Services Task Force (USPSTF). http://www.ahrq.gov/CLINIC/uspstfix.htm.(www.ahrq.gov) The USPSTF conducts impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications.

The CHPS reviews recommendations released by the USPSTF and makes recommendations to the AAFP Board of Directors. In most cases, the AAFP agrees with the USPSTF; however, there are circumstances where there are differences.

In 2007, the USPSTF changed the grading of evidence for new recommendations issued (http://www.ahrq.gov/clinic/uspstf/grades.htm(www.ahrq.gov)). Therefore, the AAFP has also changed its grading of the evidence to be more consistent with the USPSTF. The USPSTF and the AAFP are in a transition period and are implementing the use of two different grading systems for the recommendations. The first grading system applies to the recommendations that were issued before May 2007, and the second grading system applies to recommendations that were issued during or after May 2007. These grading systems are outlined below.

The AAFP grading systems for the recommendations that were issued during or after May 2007 include:

 

A
Recommendation: The AAFP recommends the service. There is high certainty that the net benefit is substantial.
  
BRecommendation: The AAFP recommends the service. There is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial.
  
CRecommendation: The AAFP recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.
  
DRecommendation: The AAFP recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
  
IRecommendation: The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
  
I-HBHealthy Behavior is identified as desirable, but the effectiveness of physician’s advice and counseling is uncertain.

 

Where appropriate, specific website URLs are provided that link directly to the clinical consideration section of the U.S. Preventive Services Task Force. The clinical consideration section provides additional information needed to interpret and implement the recommendations.

Physicians are encouraged to review not only the needs of individual patients they see, but also of the populations in the communities they serve to determine which population recommendations need to be implemented systematically in their practices. The recommendations contained in this document are for screening, chemoprophylaxis, and counseling only. They do not necessarily apply to patients who have signs and/or symptoms relating to a particular condition.

These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.

The AAFP grading system for recommendations issued before May 2007 includes:

 

SRStrongly Recommend: Good quality evidence exists which demonstrates substantial net benefit over harm; the intervention is perceived to be cost-effective and acceptable to nearly all patients.
  
RRecommend: Although evidence exists which demonstrates net benefit, either the benefit is only moderate in magnitude or the evidence supporting a substantial benefit is only fair. The intervention is perceived to be cost-effective and acceptable to most patients.
  
NRNo Recommendation Either for or Against: Either good or fair evidence of at least a small net benefit exists. Cost-effectiveness may not be known, or patients may be divided about acceptability of the intervention.
  
RARecommend Against: Good or fair evidence which demonstrates no net benefit over harm exists.
  
IInsufficient Evidence to Recommend Either for or Against: No evidence of even fair quality exists or the existing evidence is conflicting.
  
I-HBHealthy Behavior is identified as desirable, but the effectiveness of physician's advice and counseling is uncertain.

 

Physicians are encouraged to review not only the needs of individual patients they see, but also of the populations in the communities they serve to determine which population recommendations need to be implemented systematically in their practices. The recommendations contained in this document are for screening only. They do not necessarily apply to patients who have signs and/or symptoms relating to a particular condition.

Where appropriate, specific website URLs are provided that link directly to the clinical consideration section of the U.S. Preventive Services Task Force. The clinical consideration section provides additional information needed to interpret and implement the recommendations.

These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.

The RCPS is available online or through the AAFP Order Department by calling 800-944-0000; ask for item number 962. The document is free.