Preventive Services That Providers and Care Systems Should Deliver (Based on Good Evidence (Level II)
Level II services have been shown to be effective and should be provided whenever possible. If systems/care management teams are successful in keeping patients on time with high-priority services during illness and disease management visits, preventive services in the second group can be delivered.
Refer to Table 2 above for information on Level II preventive services.
Cervical Cancer Screening
Service
All women should be screened for cervical cancer beginning at age 21 or three years after initiating sexual intercourse, whichever is earlier. Screening should be performed every three years after three consecutive normal Pap smears over five years.
Human papillomavirus (HPV) testing may be used as an adjunct to Papanicolaou (Pap) smear screening to help minimize unnecessary colposcopies and other interventions.
Women who have had dysplasia on prior Pap smears should continue with annual screening for five years after the last dysplastic Pap smear; after that, they need only every-three-year screening.
References/Related Guidelines
See the NGC summary of the ICSI Initial Management of Abnormal Cervical Cytology (Pap Smear) and HPV Testing guideline.
Evidence supporting this recommendation is of classes: C, M, R
Infant Sleep Positioning and Sudden Infant Death Syndrome (SIDS) Counseling
Service
Ask how child is positioned for sleep. Inform parents of importance of back-sleeping position. Demonstrate the appropriate sleeping position when the patient is under medical care.
Refer to the original guideline document for information on efficacy of SIDS counseling and burden of suffering.
Counseling Message
Infants should be placed on their back for sleep. Side sleeping is no longer recognized as an alternative position. Parents should be advised about the appropriate sleeping position starting in the newborn nursery. Health care workers should be careful to place babies on their back to demonstrate to parents the appropriate sleeping position. Continued work to educate all potential caregivers of infants should be supported.
Infant sleep surfaces should be firm and there should be no loose bedding or soft objects around the infant.
Parents should be encouraged not to smoke, as this has many important health benefits. Smoking during pregnancy has been shown to be associated with increased risk of SIDS.
A proximate but separate sleeping environment and the use of pacifiers have been recommended. These should be discussed with parents in the context of fully supporting breastfeeding.
Supporting evidence is of classes: C, D, M, R
Injury Prevention Counseling: Motor Vehicle Safety Screening and Counseling
Service
Ask about the use of car seats, booster seats, and seat belts in the family.
Ask about helmet use in motorcycle riders.
Refer to the original guideline document for information on the efficacy of counseling and burden of suffering from motor vehicle injuries.
Counseling Messages
Age Group - Birth to 9 Years
- Install and use federally approved child safety seats.
- Discuss the fact that infants should face the rear of the vehicle until they are both 1 year of age and 20 lbs, and should not be placed in any seat with an air bag. (Best - middle rear seat).
- All children under 4 years of age must ride in appropriate car seat.
- Discuss the fact that children between 4 to 9 years and weighing less than 80 pounds should be in a belt positioning booster seat.
All Individuals
- Discuss always wearing a safety belt when driving or riding in a car. Discuss the fact that 50% of death and disability from motor vehicle accidents can be prevented when passengers routinely wear seat belts.
- Do not drive or ride in a motor vehicle when the driver is under the influence of alcohol or drugs.
- Discuss the fact that passengers should not ride in cargo areas of any vehicle.
- The safest way to travel is to ensure that EVERYONE in the vehicle is correctly buckled up and that all children under age 13 ride in the back seat.
- For air bag safety, drivers should try to maintain at least 10 inches between themselves and the steering wheel. Front passenger seats should be moved as far back as possible.
- Motorcycle riders should always wear helmets to reduce the risk of head injury.
Evidence supporting this recommendation is of classes: B, C, M, R
Neonatal Screening
Service
Metabolic screens and other interventions in the first week of life should be performed according to state law.
Efficacy
Newborn metabolic screening is designed to detect infants with inborn errors of metabolism. Early identification in many cases can avert a poor outcome for a child with various interventions depending on the condition. Approximately 4,000 infants per year are identified with a condition through the newborn metabolic screening program. Each state varies on the test required to be done by law, but a uniform approach with all states using mass spectrometry is being promoted by a variety national groups (www.mchb.hrsa.gov/screening).
Counseling Message
All infants should receive a newborn metabolic screening test prior to hospital discharge, ideally when greater than 24 hours of age. Infants who receive screening before 24 hours of age should receive a repeat test before the second week of age.
System alerts should provide notice of positive results. Appropriate follow-up services must be provided for any child with a positive test.
Evidence supporting this recommendation is of class: R
Obesity Screening
Service
Record height, weight, and body mass index (BMI) annually beginning at age two as part of a normal visit schedule. Monitor BMI.
Refer to the original guideline document for information on efficacy of obesity screening.
Counseling Messages
Encourage wholesome eating and physical activity.
2-18 years
Encourage:
- Consumption of fruits, vegetables, whole grains, and low-fat dairy products
- Limiting total fat, especially saturated, trans fats, and cholesterol
- Daily participation of 30 to 60 minutes of moderate to vigorous physical activity appropriate for age
- Regular meals
Discourage:
- Foods with added sugars
- Sweetened beverages
- Television and video games; limit to one hour per day
References/Related Guidelines
http://www.healthierus.gov/
http://www.mypyramid.gov
See Knowledge Resources section, "Resources Available" in the original guideline document; ICSI's Technology Assessment Report on Treatment of Obesity in Children and Adolescents; and the NGC summary of ICSI guideline Prevention and Management of Obesity (Mature Adolescents and Adults).
Evidence supporting this recommendation is of classes: A, B, D, M, R
Tobacco Use Screening, Prevention, and Intervention in Adolescents
Service
Establish tobacco use and secondhand smoke exposure and reassess at every opportunity. (See section on Secondhand Smoke Exposure in the original guideline document).
Reinforce non-users to continue non-use of tobacco products.
Offer tobacco cessation services on a regular basis to all patients who use tobacco. (All forms of tobacco should be considered.)
The key components of successful office tobacco cessation interventions are:
- Ask about tobacco use and smoke exposure at every opportunity.
- Advise all users to quit.
- Assess willingness to make a quit effort.
- Assist users' willingness to make a quit attempt.
- Arrange follow-up.
Refer to the original guideline document for information on efficacy of tobacco use screening.
Counseling Messages
For children and adolescents aged 10 years and above and the child or adolescent is using tobacco:
- Emphasize short-term negative effects of tobacco use.
- Advise tobacco users to quit.
- Assess user's willingness to make a quit attempt.
- Provide counseling depending on readiness-to-quit stage. Provide a motivational intervention if the user is not ready to make a quit effort.
- Assist in quitting if ready to make a quit effort. Negotiate a quit date. Counsel to support cessation and build abstinence skills. Offer phone line for more assistance.
- Arrange follow-up to occur soon after the quit date.
For All Ages
- If accompanying household member uses tobacco, encourage member to quit. If the member user is interested in quitting, encourage a visit at his or her clinic for more cessation assistance.
- Provide educational and self-help materials.
Evidence supporting this recommendation is of class: R
5a. Preventive Services for Which the Evidence Is Currently Incomplete (Level III)
Level III services could be left to the judgment of individual medical groups, clinicians and their patients. These services either have insufficient evidence to prove their effectiveness and/or have important harms. For these preventive services in particular, decisions about offering the service should be made on a patient-by-patient basis. It is important to remember that insufficient evidence does not mean the service is not effective, but rather that the current literature is not sufficient to say whether or not the service is effective.
Please refer to the beginning of the "Major Recommendations" field and to the original guideline document for information on Level III preventive services.
5b. Screening Maneuvers That Are Not Supported by Evidence (Level IV)
Level IV services are those with low predictive value and/or uncertain beneficial action for true positives.
The list of Level IV preventive services is provided at the beginning of "Major Recommendations" field. Please refer to the original guideline document for detailed information on Level IV preventive services.