Background articleThe evolving role of prevention in health care: Contributions of the U.S. Preventive Services Task Force
Section snippets
Historical background: the journey of the U.S. preventive services task force
Although major groups had advocated annual physical examinations for decades8 and promoted routine screening tests such as blood and urine chemistry panels, chest radiographs, and electrocardiograms, a comprehensive review of the scientific evidence to support specific preventive services was lacking in the early 1980s. Doubts grew as critical review articles focused attention on the absence of data for many commonly delivered services.9 In 1979, the Canadian Task Force on the Periodic Health
The changing climate of prevention
By the time the second edition of the Guide appeared, the environment for preventive medicine and evidence-based medicine had changed dramatically. Managed care organizations, which had emerged as a dominant paradigm for delivering and paying for health care, included preventive care among basic covered services more commonly than had traditional fee-for-service insurance.4, 19, 20 At the same time, the heightened competition spurred by managed care brought increased attention to costs and
Continuing evolution of guidelines and evidence-based health care
By 1996, the enthusiasm for clinical practice guidelines and for evidence-based medicine had been tempered by a realization of their attendant practical and political challenges.22 At its inception, the U.S. Congress authorized the Agency for Health Care Policy and Research (AHCPR; renamed the Agency for Healthcare Research and Quality [AHRQ] in 1999) to develop practice guidelines as part of its twin goals of improving quality and reducing unnecessary costs. By 1995, however, controversies
The current USPSTF
It is in this context that a third USPSTF was convened in 1998 to update the recommendations of the second Task Force. Following the release of the second edition of the Guide, responsibility for the work of the USPSTF and the related Put Prevention Into Practice28 initiative (www.ahrq.gov/clinic/prevenix.htm) were transferred to AHRQ as part of its commitment to supporting evidence-based practice. Thirteen Task Force members (including four returning members) were selected from a pool of over
Implementation: the final frontier of preventive medicine
The experiences of the first and second USPSTF, as well as that of other evidence-based guideline efforts, have highlighted the importance of identifying effective ways to implement clinical recommendations. Practice guidelines are relatively weak tools for changing clinical practice when used in isolation.29, 30 To effect change, guidelines must be coupled with strategies to improve their acceptance and feasibility. Such strategies include enlisting the support of local opinion leaders, using
Future challenges
The USPSTF faces continuing challenges in its attempts to distill evidence and produce clinical recommendations (see the accompanying paper on USPSTF methods in this issue).44 Increasing explicitness of USPSTF methods cannot completely remove the subjective element involved in making recommendations based on inferences from imperfect evidence on complex issues. Nonetheless, the USPSTF continues to adhere to the general principle that it is appropriate to set a high standard of evidence for
References (48)
- et al.
Health promotion and managed caresurveys of California’s health plans and population
Am J Prev Med
(1998) - et al.
Clinician satisfaction with a preventive services implementation trialthe IMPROVE project
Am J Prev Med
(2000) - et al.
Self-report of delivery of clinical preventive services by U.S. physicianscomparing specialty, gender, age, setting of practice, and area of practice
Am J Prev Med
(1999) - et al.
Mandated coverage for cancer-screening serviceswhose guidelines do states follow?
Am J Prev Med
(2000) - et al.
Shared decision making in clinical medicinepast research and future directions
Am J Prev Med
(1999) - et al.
Actual causes of death in the United States
JAMA
(1993) - Starfield B. Primary care: balancing health needs, services, and technology. New York: Oxford University Press,...
- National Center for Health Statistics. Healthy People 2000 review, 1998–99. Hyattsville, MD: U.S. Public Health...
- Partnership for Prevention. Results from the William M. Mercer survey of employer-sponsored health plans. Washington,...
- Partnership for Prevention. Recommendations to the Congressional Prevention Coalition: nine high-impact actions...
Historical changes in the objectives of the periodic health examination
Ann Intern Med
A critical review of periodic health screening using specific screening criteria
J Fam Practice
Practice guidelinesa new reality in medicine. I. Recent developments
Arch Intern Med
Rules of evidence and clinical recommendations on the use of antithrombotic agents
Arch Intern Med
Trends in adult visits to primary care physicians in the United States
Arch Fam Med
Cited by (60)
From 'D' to 'I': A critique of the current United States preventive services task force recommendation for testicular cancer screening
2016, Preventive Medicine ReportsCitation Excerpt :Some have advocated that the Task Force provide ‘clinical options’ (especially if the harms and costs with performing a particular service are minimal) or that services, which have not been adequately studied, should not be recommended (Woolf and Atkins, 2001). Some suggest that a neutral stance should be taken (meaning not recommending for or against a service) until better evidence is available or that those who are deemed high-risk should be informed of the benefits of performing regular TSE (Woolf and Atkins, 2001; American Urological Association [AUA], 2014). Others explicitly state (i.e. the Society for Adolescent Health and Medicine, 2012) their support for TCa screening or suggest that identified high-risk males (i.e. Caucasian race, being between the ages of 15–40, family history of the disease, and/or the occurrence of cryptorchidism) should ‘seriously’ consider performing monthly exams (ACS, 2015).
Evidence-Based Practice
2015, International Encyclopedia of the Social & Behavioral Sciences: Second EditionThe role of disease management programs in the health behavior of chronically ill patients
2014, Patient Education and CounselingCitation Excerpt :Health behaviors such as smoking and physical inactivity are important risk factors for many chronic diseases and leading causes of death and disability [14]. While little is known about how to best improve health behaviors of chronically ill patients in the primary care setting [15–19], we do know that effective and high-quality chronic care, including preventive health behavior interventions that actively involve chronically ill patients and improve their quality of life, is needed [20]. Comprehensive system changes, rather than simply implementing sole interventions or adding new features to the existing acute-focused system, are needed to provide effective and high-quality chronic care [9–13].
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Reprints are available from the AHRQ Web site at www.ahrq.gov/clinic/uspstfix.htm, through the National Guideline Clearinghouse (www.guideline.gov), or in print through the AHRQ Clearinghouse (1-800-358-9295).