Providing health care for women at all stages of life is a key part of family medicine, so it should come as no surprise that the AAFP is partnering with the American College of Obstetricians and Gynecologists (ACOG), the American College of Physicians and the National Association of Nurse Practitioners in Women's Health in a multiyear project to enhance women's overall health.
Specifically, the Academy is working with these other groups to offer recommendations for updating the so-called Women's Preventive Services Guidelines(www.hrsa.gov) established in 2011 pursuant to enactment of the Patient Protection and Affordable Care Act (ACA), which focused on the use of preventive health services to foster optimal health and well-being.
This preventive guidance is intended to complement, build on and fill gaps in existing guidelines provided by the United States Preventive Services Task Force,(www.uspreventiveservicestaskforce.org) the American Academy of Pediatrics' Bright Futures initiative,(brightfutures.aap.org) and the CDC's Advisory Committee on Immunization Practices.(www.cdc.gov)
- The AAFP is collaborating with the American College of Obstetricians and Gynecologists and other health professional organizations in a multiyear project to enhance women's overall health.
- The Academy is working with these other groups to offer recommendations for updating the Women's Preventive Services Guidelines established in 2011.
- Family physicians have an opportunity to participate in the initiative by commenting on a draft recommendation regarding postpartum diabetes screening for women with a history of gestational diabetes.
In keeping with its focus on prevention as a means to improve downstream health outcomes and rein in costs, the ACA called for HHS to develop a list of preventive services that health plans would be required to cover with no cost-sharing.
As part of this effort, HHS tasked the Institute of Medicine (IOM), now known as the National Academy of Medicine, with reviewing what preventive services are important to women's health and well-being and recommending which of those services should be considered when developing comprehensive guidelines. The IOM's report, Clinical Preventive Services for Women: Closing the Gap,(www.nationalacademies.org) included eight such recommendations covering the following areas:
- screening for gestational diabetes,
- HPV testing as part of cervical cancer screening for women older than 30,
- counseling on sexually transmitted infections,
- counseling and screening for HIV infection,
- contraceptive methods and counseling to prevent unintended pregnancies,
- lactation counseling and equipment to promote breastfeeding,
- screening and counseling to detect and prevent interpersonal and domestic violence, and
- annual well-woman visits to obtain recommended preventive services.
It should be noted that language in the ACA explicitly included screening mammography among services to be covered at no cost to patients.
"This report provides a road map for improving the health and well-being of women," said Linda Rosenstock, M.D., M.P.H., (then) dean of the School of Public Health at the University of California, Los Angeles, and chair of the IOM committee that developed the report, in a news release(www8.nationalacademies.org) issued at the time. "The eight services we identified are necessary to support women's optimal health and well-being. Each recommendation stands on a foundation of evidence supporting its effectiveness."
Since then, the science around these areas has advanced, and a number of research gaps have been identified, such as the need to place greater emphasis on practice-based clinical needs. For these reasons, and to follow the IOM report's recommendation that this guidance be updated at least every five years, the Health Resources and Services Administration (HRSA) was charged with implementing a regular method for updating and potentially expanding the recommendations.
And so it was that in March 2016, HRSA awarded ACOG about $950,000 in funding per year for a five-year cooperative agreement to design and facilitate a collaborative coalition process for reviewing and recommending updates to the current Women's Preventive Services Guidelines.
Enter the Women's Preventive Services Initiative,(www.womenspreventivehealth.org) which published its initial abridged report, Recommendations for Preventive Services for Women,(www.womenspreventivehealth.org) in December 2016. The recommendations the AAFP, ACOG and the other groups are now formulating aim to aid clinicians and patients in determining which services will benefit patients, as well as to help ensure coverage for those recommended services.
As that group continues its work, family physicians have an opportunity to participate by commenting on a draft recommendation regarding postpartum diabetes screening for women(www.womenspreventivehealth.org) with a history of gestational diabetes.
Specifically, the Women's Preventive Services Initiative "recommends women with a history of gestational diabetes mellitus (GDM) who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes mellitus should be screened for diabetes mellitus. Initial testing should ideally occur within the first year postpartum and can be conducted as early as 6 weeks postpartum."
Confirmatory diagnostic testing is indicated for women who have a positive postpartum screening test result, regardless of the initial test used (e.g., oral glucose tolerance test, fasting plasma glucose or hemoglobin A1c). In addition, women with a negative initial screening test result should be rescreened at least every three years for a minimum of 10 years after pregnancy, the draft states.
Finally, repeat testing should be performed in women who were screened with hemoglobin A1c in the first six months postpartum regardless of the result of that test.
Along with those clinical recommendations, the draft statement offers implementation considerations, provides recommendations for further research and includes a complete list of references used in its development. Comments on the draft recommendation will be accepted through 11:59 p.m. PDT on June 22.
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