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Title & Content |
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Encouraging Preventive Screenings
New "News" from the
U.S. Preventive Service Task Force
Therese Miller, DrPH
Mary Barton, MD, MPP
Claire Kendrick, MSEd
Iris Mabry, MD, MPH
Janice Genevro, PhD
(image: AHRQ logo) |
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AHRQ Mission Statement
To improve the quality, safety, efficiency, and effectiveness of health care for all Americans
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Congressional Mandate
Under Title IX of the Public Health Service Act, (42 U.S.C. 299-299c-7 as amended by Public Law 106-129 (1999):
ESTABLISHMENT AND PURPOSE –
The Director may periodically convene a Preventive Services Task Force to be composed of individuals with appropriate expertise. Such a task force shall review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community, and updating previous clinical preventive recommendations.
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History of the USPSTF & AHRQ
- 1976 - Canadian Task Force on PHE
- 1984 - USPSTF established by PHS
- 1998 - 3rd USPSTF reconvened by AHRQ
- 2001 - Task Force made a standing body
(image: US Preventive Services Task Force 20th Anniversary 1984-2004)
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Current USPSTF Members as of January 2006
Bruce N. (Ned) Calonge, M.D., M.P.H. (Chair)
Diana B. Petitti, M.D., M.P.H. (Vice Chair)
Thomas G. DeWitt, M.D.
Leon Gordis, M.D., M.P.H., Dr.P.H.
Kimberly D. Gregory, M.D., M.P.H.
Russell Harris, M.D., M.P.H.
George Isham, M.D., M.P.H.
Michael LeFevre, M.D., M.S.P.H.
Carol J. Loveland-Cherry, Ph.D., R.N.
Lucy N. Marion, Ph.D., R.N.
Virginia A. Moyer, M.D., M.P.H.
Judith K. Ockene, Ph.D., M.Ed.
George F. Sawaya, M.D.
Albert L. Siu, M.D., M.S.P.H.
Steven M. Teutsch, M.D., M.P.H.
Barbara Yawn, M.D., M.Sc.
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Task Force Activities
- Provide evidence-based scientific reviews of preventive health
services for use in primary healthcare delivery settings
- Age- and risk-factor specific recommendations for routine practice
- Recommendations include:
- Screening tests
- Counseling
- Preventive medications
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What the USPSTF Says…
The U.S. Preventive Services Task Force (USPSTF)
recommends against routine referral for genetic
counseling or routine breast cancer susceptibility
gene (BRCA) testing for women whose family
history is not associated with an increased risk for
deleterious mutations in breast cancer
susceptibility gene 1 (BRCA1) or breast cancer
susceptibility gene 2 (BRCA2).
Rating: D Recommendation
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What the USPSTF Says…
Rationale: The USPSTF found fair evidence that women without certain
specific family history patterns, termed here "increased risk family history" (go
to Clinical Considerations for a definition), have a low risk for developing
breast or ovarian cancer associated with BRCA1 or BRCA2 mutations. Thus,
any benefit to routine screening of these women for BRCA1 or BRCA2
mutations, or routine referral for genetic counseling, would be small or zero.
The USPSTF found fair evidence regarding important adverse ethical, legal,
and social consequences that could result from routine referral and testing of
these women. Interventions such as prophylactic surgery, chemoprevention,
or intensive screening have known harms. The USPSTF estimated that the
magnitude of these potential harms is small or greater. The USPSTF
concluded that the potential harms of routine referral for genetic counseling or
BRCA testing in these women outweigh the benefits.
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What Clinicians Want to Hear…
Do it
Don't do it
We don't know
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What the USPSTF Grades Mean
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Examples
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Grade
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Grade Definitions
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A
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The USPSTF recommends the service. There is high certainty that the net benefit is substantial.
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D
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The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
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USPSTF Levels of Certainty Regarding Net Benefit
Definition:
The U.S. Preventive Services Task Force defines
certainty as "likelihood that the USPSTF
assessment of the net benefit of a preventive service
is correct". The net benefit is defined as benefit
minus harm of the preventive service as implemented
In a general, primary care population. The USPSTF
assigns a certainty level based on the nature of the
overall evidence available to assess the net benefit of
a preventive service.
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Suggestions for Practice
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Grade
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A
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Offer/provide this service.
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B
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Offer/provide this service.
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C
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Offer/provide this service only if there are other considerations in support of the offering/providing the service in an individual patient.
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D
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Discourage the use of this service.
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I
Stmt
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Read "Clinical Considerations" section of USPSTF Recommendation Statement. If offered, patients should understand the uncertainty about the balance of benefits and harms.
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Screening for Chlamydia Infection
| Population |
Non-Pregnant Women |
Pregnant Women |
Men |
| Younger than 25 yrs |
Older than
25 yrs |
Younger than 25 yrs |
Older than
25 yrs |
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includes adolescents |
Low Risk |
High
Risk |
includes adolescents |
Low Risk |
High Risk |
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| Rec |
A
Screen if Sexually Active |
C |
A
Screen if Sexually Active |
B
Screen |
C |
B
Screen |
No recommendation due to insufficient evidence.* |
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| Risk Factors |
History of: previous Chlamydia
infection, other sexually transmitted infections, new or multiple
sexual partners, inconsistent condom use, sex work.
Prevalence is higher in African-American women, Latinas,
military recruits, patients at public STI clinics, and incarcerated
populations.
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| Screening Tests |
Nucleic acid amplification tests (NAATs)
can identify Chlamydia infection in asymptomatic women (non-pregnant
and pregnant) and asymptomatic men.
NAATs have high specificity and sensitivity and can be used with
urine and vaginal swabs. |
| Screening Intervals |
Non-Pregnant Women |
Pregnant Women |
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The optimal interval for screening is
not known.
The CDC recommends that women at increased risk be screened at least
annually.1 |
For patients at risk: Screen at the
first prenatal visit.
For patients at continuing risk, or who are newly at risk: Screen in
the 3rd trimester. |
| Treatment |
The Centers for Disease Control and
Prevention have outlined appropriate treatment.
http://www.cdc.gov/STD/treatment/4-2002TG.htm#Chlamydia
Test
and/or treat partners of patients treated for Chlamydia infection. |
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Resources for Primary Care Clinicians
www.preventiveservices.ahrq.gov
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The Guide to Clinical Preventive Services 2006
- United Health Foundation to distribute 430,000 to primary care clinicians
- Partnership with CDC (ACIP)
(image: cover of "The Guide to Clinical Preventive Services 2006")
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(image: chart titled "Adult Preventive Care Timeline" presents preventive health services recommended for adults pertaining to heart health, cancer, health risks, sexual health, bone health, depression, and immunizations)
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ePSS - Electronic
Preventive Services Selector Tool
- Released YESTERDAY
- Search USPSTF recommendations by age, sex and risk factors
- Available as a web-based tool or can be downloaded to your PDA
- www.epss.ahrq.gov
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(image: screenshot of "Search for Recommendations" web page from AHRQ web site)
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(image: screenshot of AHRQ PDA version of the tool as it would appear on a Pocket PC device)
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Encouraging Preventive Screenings
(image: cartoon titled "Way Too General Practitioner" showing General Practitioner stating "Could be anything" as he examines patient)
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