24 SECTION 3 Preventive Medicine and public Health Table 18-6 Recommended Screening Tests for Men Sc Ages 18-39 Ages 40-49 Ages 50-64 Age 65 and Olde aneurysm screen if age 65-75 Blood pressure(BP) At ery 2 At least every 2 years if (<20/80mmHg) (<120/80mmHg) if Bp between 120/80 etween 120/80 and between 120/80 and 139189 tment hent with Discuss treatment with th physician or with physician or urse if BP 140/90 4090 BP 140/90 or higher. lan or nurse creased risk for nurse how oft ou need testing. 气m At age 35 and older, nurse how often ou need testing Through age 75 Clan or nurse lan o test is best for you and test is best for you and need it how often you need it Diabetes screening If BP higher than If BP higher than If BP higher than If bp is h 35/80 mm Hg or if if taking medicine taking medicine for king medicine high BP high BE Human If at increased risk at increased risk for immunodeficiency for hIV infection HIV infection HIV infection Discuss your risk Discuss your risk Discuss your risk with Discuss your risk with ysIc h physician or physician or nurs nurse nurse. If at increased ris If at increased risk If at increased risk If at increased risk Datafromhttp://www.womenshealth-gov/screening B. Limits of Evidence prove to confer net harm. Practice must evolve in tandem with an evolving base of evidence. One important aspect of Task Force recommendations is that they can be, and often are, noncommittal. When evi- dence is lacking or inconsistent, the Task Force may conclude C. CLinical Preventive Service Compliance that neither a recommendation for nor a recommendation One of the important themes to develop recently in the field against a practice is justified. This has two important impli- of clinical preventive service delivery is that compliance cations. First, judgment remains a vital element in clinical should not be measured for a given service, but rather f practice even in the EBM era. Although it may be reasonabl he "bundle of services" recommended for an individual to recommend neither for nor against a practice in general, based on age and gender. Several such"bundled metrics a given patient will either receive or not receive a service. At have been proposed, based on Behavioral Risk Factor Sur the individual level, even the failure to make a decision veillance System(BRFSS) data or computerized record proves to be a decision. Consequently, many topics addressed Such packaging of metrics (1)improves accountability, by the Task Force revert to a process of dialogue and shared raising the bar for performance, and (2 )directs the focus to decision making between clinician and patient. Such deci- underserved patients, because the only improves if sions are influenced by individual priorities, preferences, and most patients receive all services. For this reason, a packaged at times economics; practices not formally recommended measure of up-to-date preventive services has recently been may not be routinely covered by third-party payer added to the Healthy People 2020 indicators he second implication of USPSTF's noncommittal pproach is that"no evidence of benefit is not the same as evidence of no benefit. A practice that may ultimately TAYING CURRENT prove to be of decisive benefit may not be recommended The USPSTF offers many ways in which providers can stay because the relevant evidence has not yet accrued(see Box current and access recommendations at the point of care 16-2). The same is true of a practice that may ultimately These include a pocket guide to the preventive services, an