Clinical Preventive services (United States Preventive Services Task Force CHAPTER OUTLINE A. Mission and History 1. UNITED STATES PREVENTIVE SERVICES TASK FORCE 217 When the USPSTF was first convened by the U.S.Public Health service in 1984. it was modeled on an earlier B. Underlying Assumptions 217 Canadian task force to serve as an independent panel of C. Evidence Review and Recommendations 2 8 experts on prevention and evidence-based medicine(EBM) II. ECONOMICS OF PREVENTION 220 Since 1995, the Task Force has worked under the Agency of A. Overuse, Underuse, and Misuse of Screening 220 Healthcare Research and Quality (AHRQ). It covers all Ill. MAJOR RECOMMENDATIONS 221 rimary and secondary preventive services, including screen A. Highly Recommended Services 221 ing, counseling, and specific chemoprophylaxis. The Task B. Limits of Evidence 224 Force aims to provide accurate and balanced recommenda tions across a spectrum of populations, types of services, and IV, COMMUNITY-BASED PREVENTION 225 disease types. Its mission is t V. SUMMARY 225 1. Assess the benefits and harm of delivering preventive ser REVIEW QUESTIONS, ANSWERS, AND EXPLANATIONS O (based on age, ger ch services should be primary care. This mission is very circumscribed, The USPSTF only considers screening of asymptomatic patients, and it only deals with services within primary however. USPSTF sized by cialist organizations. Specialists may primarily see prese In Chapter 16, we explored how screening is, in the most lected patients with subtler symptoms that were missed literal sense, "looking for trouble. " Looking for trouble makes earlier or may see high-risk groups. Screening decisions for ense if, by finding it early, it can be fixed. But if you dont such patients may be different from those for the general know what to do with the trouble you find, you are no longer population, because the pretest probability of disease is just looking for trouble, you are asking for it. The credibility much higher. On the other hand, recommendations of of preventive medicine depends on the following two goals: USPSTF are sometimes used for insurance decisions about a Screening is only done if it meets rigorous standard which screening tests to cover. In these cases, recommenda The screening test can real istically be integrated in the tions may be more broadly applied than intended. In con- busy practice of all clinicians trast to the Community Preventive Services Guide(see Chapter 26), the USPStF does not take cost-effectiveness or financial concerns into consideration When the USPSTF was founded, its principles were revolu- . UNITED STATES PREVENTIVE tionary: that preventive care should be rigorously evaluated, and that not every screening test was worth doing. In its history, SERVICES TASK FORCE USPSTF has often recommended against or failed to endorse screening tests that were recommended by other organizations. The U.S. Preventive Services Task Force(USPSTF)was The reason for this reluctance to endorse some interventions founded in 1984 to address these goals. This chapter focuses may be based on several assumptions of the Task Force on why its work is important and how busy clinicians can keep up-to-date with and incorporate the Task Force's rec ommendations. Recommendations for clinical preventive B. Underlying Assumptions ervices change frequently with emerging evidence. For more As outlined in Chapter 16, screening studies are subject to details and updated recommendations, readers should many biases that lead researchers to overestimate benefits. consult USPSTF online(see Website list at end of chapter). Therefore the Task Force places a higher burden of evidence