Release of the Guide to Clinical Preventive Services, Second Edition

blue bullet U.S. Preventive Services Task Force Press Conference Agenda

blue bullet U.S. Preventive Services Task Force Press Release 

blue bulletRemarks:

Philip R. Lee, M.D.
Assistant Secretary for Health
U.S. Department of Health and Human Services
Press Conference
Report of the U.S. Preventive Services Task Force
Washington, D.C.

It is my pleasure to announce the release of the Guide to Clinical Preventive Services, 2nd Edition. This document is the most up-to-date, comprehensive, and authoritative prevention reference available to doctors, nurses, and other health care practitioners. The Guide reflects the knowledge we have gained in the six years since the 1989 landmark report of the U.S. Preventive Services Task Force. Thanks to their pioneering work, we know that appropriate prevention works: It saves lives, improves the quality of life, and makes wise use of America's limited health care resources.

The U.S. Department of Health and Human Services is deeply committed to improving the quality and delivery of preventive services. Prevention, after all, doesn't just happen. It is the result of practitioners and patients working together, basing their decisions on the best scientific evidence available.

The Department's umbrella initiative to improve prevention is "Healthy People 2000"--a national strategy for preventing chronic illnesses, injuries, and infectious diseases. That strategy includes programs such as the public-private partnership known as "Put Prevention Into Practice," which gives doctors and nurses important tools to provide effective prevention to their patients. In our recent mid-course review of progress toward the "Healthy People 2000" goals, we learned that although great strides have been taken, we still have a long way to go.

The Task Force report released today represents a significant landmark on the road toward a healthier Nation. Its science-based recommendations will sharpen and refocus America's preventive services, helping practitioners provide the best possible care to their patients.

J. Michael McGinnis, M.D.
Former Deputy Assistant Secretary for Health
Disease Prevention and Health Promotion
U.S. Department of Health and Human Services
Press Conference
Report of the U.S. Preventive Services Task Force
Washington, D.C.

The Guide to Clinical Preventive Services is an important example of Government meeting its obligation to ensure that the best knowledge and skills of both the public and the private sectors are brought together on behalf of the American people. There are three features of this Guide that make it particularly notable:

The work of the Task Force is pioneering in this regard. It has its roots in clinical studies for various interventions, some of which extend back many years; in the work of the Canadian Task Force on the Periodic Health Exam, which made a major contribution in the 1970s to the application of evidence-based decision criteria; and in the work of various professional societies and Government agencies to develop consensus statements on interventions within their purview. But the U.S. Preventive Services Task Force was the first to address the issues in such a comprehensive and systematic fashion. This 1995 version extends and improves upon the approach and its results, offering important new guidance to the practice of preventive medicine in this country.

Medical care in the United States is undergoing a period of dramatic change. As those changes evolve, three mandates are vital: to ensure that the system helps to keep people healthy, not merely to contend with the results of missed prevention opportunities; to ensure that the system delivers value for the dollars invested--that it delivers what has been proven to work; and to ensure that medical services are available to all who need them. The Task Force, and this Guide, offer guidance of fundamental importance to meeting the first two of these mandates. Furthermore, by concentrating our efforts on prevention that works, we may move closer to our goal of providing affordable and effective medical care to all.

Harold Sox, M.D.
Professor of Medicine
Dartmouth Medical School
Chair, U.S. Preventive Services Task Force
Press Conference
Report of the U.S. Preventive Services Task Force
Washington, D.C.

I welcome the opportunity to speak about the second edition of the Guide to Clinical Preventive Services. For nearly a year, I have been receiving telephone calls from physicians who care deeply about the quality of preventive services that they provide. Their first question is the release date for the second edition of the Guide; then, they want a preview of new recommendations for their favorite topics. To these wonderful doctors, who care so much, I can now say, "The report is out." They will be happy, but I will miss those phone calls that remind me that many physicians care a great deal about being up to date with the science of medical practice.

The Guide contains recommendations, or guidelines, about the best preventive practices for over 70 conditions. There are over 200 individual recommendations. The content is all new and includes age-specific tables of recommendations. The book covers screening, counseling, and immunizations and medications to prevent disease.

The key to the widespread influence of the first edition of the Guide has been the rigor with which the Task Force evaluated the evidence and its insistence upon strong evidence as a precondition to an unequivocal recommendation. We believe that the second edition will earn, in its own right, a reputation for integrity. Before writing each chapter, the professional staff of the Task Force performed a comprehensive search of the published literature and carefully evaluated the quality of the evidence in each article. All in all, they reviewed over 6,000 medical articles in preparing the chapters in this report. Later, experts in the field reviewed each chapter. Some chapters required several iterations of revision and expert review to ensure that they adequately reflected all of the available evidence.

Unlike the first edition, the 1995 Guide includes grades that the Task Force assigned to each recommendation. The grade, which depends on the quality of the evidence, characterizes the strength of each recommendation. The grade will help primary care practitioners when they and their patients discuss the pros and cons of doing something now to prevent trouble later on. Health practitioners are eager for this guidance, because they go out on a limb when they recommend something to a healthy person. Healthy people have nothing to gain from following a recommendation for an ineffective intervention, and they could suffer harm. With the publication of this guide, health practitioners and their patients have a handy source of authoritative guidance.

The highlights of the recommendations include the following:

In closing, let me note an important trend in health care: the formation of a partnership between well-informed patients and practitioners. Patients must know the facts before they can make an informed decision. The physician's main role in this partnership is to know the benefits and potential harms of preventive interventions, to know how to apply this knowledge to the patient, and to discuss the facts with the patient. The first edition of the Guide to Clinical Preventive Services has been an irreplaceable tool in practitioners' daily work. The 1995 Guide now provides them the opportunity to further enhance their practice of evidence-based medicine.

Donald M. Berwick, M.D.
President and CEO
Institute for Healthcare Improvement
Vice-Chair, U.S. Preventive Services Task Force
Press Conference
Report of the U.S. Preventive Services Task Force
Washington, D.C.

Thank you for the chance to offer some of my impressions as Vice-Chair of the U.S. Preventive Services Task Force. Working with the Task Force has been a true highlight of my professional career, and it has been a privilege to work with such a fine group of colleagues and staff.

Although the primary aim of the Task Force was to reach specific conclusions about individual preventive services, we also formed some general impressions about current approaches to prevention as a whole.

First, we found that it is vitally important for prevention to address patients' personal health practices. A great deal of science supports the conclusion that the choices people make about their own lifestyles and behaviors strongly affect their health--much more strongly than anything medicine, alone, can do. The main enemies of life and health--the avoidable enemies --are behaviors such as smoking, unwise dietary practices, and abuse of alcohol and other drugs. Health care practitioners can help patients avoid these enemies by counseling them to make sound choices, and by giving them information to support those choices.

Second, clinicians and patients should share decisionmaking about preventive services. Decisions about whether to have a test or procedure require balancing patient preferences along with the scientific evidence. For example, a fully informed patient is in the best position to decide whether an uncomfortable screening test is worth the discomfort. Whether a prenatal screening test should be done depends a lot on what a family would do based on the results of the test. No simple review of science can answer all the important questions about which preventive practices to use. The relationship between the clinician and the patient, not a printed research article, is still the best foundation for good health care.

Third, clinicians should be selective in providing preventive services. Health care is under great pressure today to control costs, and managed care organizations and others are struggling with ways to do so while maintaining or improving quality of care. We think that our findings can help in that direction. Science-based prevention can save money--and provide high-quality care--by avoiding unnecessary tests and procedures. Many of the preventive practices we reviewed simply do not stand up to scientific scrutiny, such as routine screening electrocardiograms and widespread electronic fetal monitoring. We identify even more opportunities to tailor prevention to specific vulnerable groups. In choosing a prevention package, one size does not fit all.

Fourth, our work suggests that every encounter with a clinician is an opportunity for prevention. Children can safely receive needed immunizations even on visits for minor illnesses; adults can be advised to stop smoking while being treated for minor injuries; inquiries about alcohol abuse can be made and appropriate counseling begun in emergency departments. This is most crucial for people who, because they lack health insurance or a stable source of care, appear in the medical system only sporadically, and rarely for a preplanned "checkup."

Fifth, for some health problems, community-level interventions may be more effective than clinical preventive services. Our research suggests that while the clinician's office is a powerful site for prevention, community-level interventions can be even more powerful for pursuing aims such as injury prevention or smoking cessation.

In today’s rapidly changing health care system, two improvements are crucial: reducing costs and improving health. Is it possible to do both at the same time? My experience with the Task Force says it is. We can reduce costs by conscientiously avoiding preventive practices that do not help, instead focusing resources where the evidence says we should. If we do that, and if we continue to design even more effective preventive methods, we have a tremendous opportunity to save years and years of life, and to help people live better during those years. Prevention has great promise, and prevention grounded in science has the greatest promise of all.

Douglas B. Kamerow, M.D., M.P.H.
Director, Clinical Guideline Development
Agency for Health Care Policy and Research
U.S. Public Health Service
Press Conference
Report of the U.S. Preventive Services Task Force
Washington, D.C.

Good morning. I am here wearing two hats today: first as the former staff director for the Task Force and the managing editor of the first and second editions of this book, and second, as the current director of clinical practice guideline development at the Public Health Service's Agency for Health Care Policy and Research. In both capacities, I am delighted to add my congratulations to the members of the U.S. Preventive Services Task Force on the release of the second edition of the Guide. It is an outstanding achievement. I want to speak for a minute this morning about the future of the U.S. Preventive Services Task Force.

In the six years since the first edition of the Task Force report was published, it has been very influential, both in content and in form. As you have heard, these preventive care guidelines themselves have been widely implemented by professional societies, managed care organizations, health departments, business coalitions on health, and others. But the U.S. Preventive Services Task Force methodology and guiding principles have also been important. Many of the organizations now developing clinical practice guidelines--including my own agency, AHCPR--have learned from the U.S. Preventive Services Task Force process, and have adopted or adapted its evidence-based methodology for use in their own guideline development.

AHCPR is the Public Health Service agency that is mandated by Congress to improve the quality of health care through health services research and guidelines, and I am pleased to announce this morning that, with the publication of the second edition of the Guide to Clinical Preventive Services, the future operations of the U.S. Preventive Services Task Force will be moving to AHCPR to join our other guideline activities. This transfer, engineered by Dr. Lee, Dr. McGinnis, and AHCPR Administrator Dr. Clifton R. Gaus, will insure ongoing support for the Task Force's important work.

We at AHCPR look forward to expanding our work on preventive care guidelines, and we welcome the U.S. Preventive Services Task Force and its staff to our agency. We pledge to continue the tradition of supporting the development of up-to-date, high-quality, evidence-based preventive care guidelines on topics that are important to the health of Americans.

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