Clinical Preventive Services

The Policy Problem

A significant fraction of the burden of illness can be averted through primary prevention services aimed at preventing the onset of disease or disability (e.g., immunizations) or secondary prevention services to identify and detect disease in its earliest stages, before noticeable (e.g., cancer screening).

Policy Options

Clinical preventive services include primary and secondary preventive services in apparently healthy persons. Such services may be provided by doctors, nurses and other health practitioners; they include screening tests, counseling, immunizations, and preventive medications. While what is appropriate depends on age, sex, and risk factors for disease.  USPSTF recommendations cover 30 different preventive services, a list that grows each year with advances in medicine and/or evidence regarding the clinical effectiveness of such services.

Policy Recommendations

• USPSTF. Recommendations for Clinical Preventive Services . The U.S. Preventive Services Task Force (USPSTF) was convened by the Public Health Service to rigorously evaluate clinical research in order to assess the merits of preventive measures. The group issues evidence-based, “gold-standard” recommendations on a comprehensive range of clinical preventive services.  USPSTF recommends that clinicians discuss these preventive services with eligible patients and offer them as a priority. All recommended services have received an “A” (strongly recommended) or a “B” (recommended) grade from the Task Force. An on-line list includes all recommendations: active, inactive, and in progress.
• USPSTF. Guide to Clinical Preventive Services, 2008: Recommendations of the U.S. Preventive Services Task Force. AHRQ Publication No. 08-05122, September 2008. Agency for Healthcare Research and Quality, Rockville, MD. This annually updated pocket guide for use by doctors, nurses and other health practitioners is current through September 2008. More recent recommendations are available through the list above. Recommendations are organized for quick reference and easy searching. One section matches recommended preventive services to patients—men, women, pregnant women, and children. [Web Version][pdf][Order]
• USPSTF. The USPSTF Electronic Preventive Services Selector (ePSS), available via PDA or on the Web at http://epss.ahrq.gov, allows users to search USPSTF recommendations by patient age and other clinical characteristics.
• Agency for Healthcare Research and Quality (AHRQ). The National Guideline Clearinghouse™ (NGC) contains syntheses of selected guidelines that cover similar topic areas. Key elements of each synthesis include the scope of the guidelines, the interventions and practices considered, the major recommendations and the corresponding rating schemes and strength of the evidence, the areas of agreement, and the areas of disagreement.  Syntheses are available for screening for breast cancer, cervical cancer, lung cancer, ovarian cancer, prostate cancer, and lipid disorders in adults; skin cancer screening and prevention, nutritional management for diabetes, assessment and treatment of obesity and overweight in adults and management of obesity/overweight in children/adolescents, and cessation of tobacco use.
• American Medical Association. Guidelines for Adolescent Preventive Services. AMA recommendations on comprehensive clinical preventive services for adolescents, for use by doctors, nurses and other health practitioners.

Policy Considerations

• Partnership for Prevention. Why Invest? Recommendations for Improving Your Prevention Investment. This report includes examples from organizations investing in preventive services for their employees and recommendations to employers for increasing the coverage and use of preventive services.

Implementation

• Partnership for Prevention. Preventive Services: Helping Employers Expand Coverage. Partnership conducted a national survey to determine the extent that employers nationwide cover recommended clinical preventive services. Results have been published in the American Journal of Health Promotion 20(3):214-22. Click here to view the abstract.
• Partnership for Prevention. Why Invest? Recommendations for Improving Your Prevention Investment. A report offering an overview of the results of a national survey determining employer coverage for clinical preventive services, and comparing the results to key findings from Partnership’s most recent analysis of services recommended by the U.S. Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP).

Resources

• USPSTF. The U.S. Preventive Services Task Force (USPSTF), first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the “gold standard” for clinical preventive services.
• USPSTF. Sign Up for Preventive Services E-mail Updates.
• USPSTF. Dissemination and Implementation: Put Prevention Into Practice (PPIP). Improving the delivery of appropriate clinical preventive services with tools and resources to support health care organizations and engage the entire health care delivery system. Includes links to Tools & Resources, Partnerships, and PPIP Case Studies.
• USPSTF. Preventive Services Resource Links.