CHAP ER 8 CLinical Preventive Services (united States Preventive Services Task Force) Accountable agency: SPARC Local data preventive services services Patient office-based ervice delivery s points for reventive services Figure 18-1 SPARC modeL. Sickness Prevention Achieved through Regional Collaboration(SPARC)for delivery of preventive services. (From Shenson D, Benson W. Harris hronic Dis 15: 1-8, 2008) electronic preventive services selector based on age and V. SuMMARY from the Task Force, 23 a subscription to e-mail updates gender of patients, and The U.S. Preventive Services Task Force follows a rigorous process to assess the benefits and harm of delivering preven tive services to asymptomatic individuals. Five letter grades IV. COMMUNITY-BASED PREVENTION summarize the evidence for net benefits or harm for services, including chemoprevention, counseling, and screening Despite many efforts among primary care providers, tive services continue to be underused, and dispari A-High certainty the service is beneficial access to screening persist. Since many preventive services B--Moderate certainty service is beneficial are portable, they can be delivered in a community setting as CAt least moderate certainty that net benefit is small. well as in a physician's office. The CDC recommends D-At least moderate certainty of no net benefit or net linking community and clinical strategies, particularly those harm I-Evidence is lacking or conflicting that focus on underserved populations. Some states have experimented with combining linkage to community ser- In clinical practice, screening tests are underused,over ices, with enhanced reimbursement for preventive services yece very of many clinical preventive services for which Ised,and misused. Considerable clinical judgment is required and use of intensively trained clinical and process coaches. One way to expand prevention outside idence remains equivocal. Providers need to deliver all office is community collaboration. Historically, preventive recommended services consistently. For services with lower medicine has focused on the physician as the main point of grades, clinicians should engage patients in meaningful con delivering preventive services. However, other models are versations about the evidence and their risk preferences. This possible. For example, in the Sickness Prevention Achieved will likely require major restructuring of care delivery and through Regional Collaboration(SPARC) model, public innovative models of community-based prevention. health agencies, hospitals, and social service organizations collaborate to integrate preventive services into other com munity events, such as polling stations on election day or the References delivery of meals on wheels(Fig. 18-1). This approach has I. Katz DL: PSA: Please stop asking(for trouble), Huffington been used successfully to increase rates of vaccination for Post,2011.http://www.huffingtonpost.com/david-katz-md/ influenza, pneumococcus, hepatitis B, and tetanus, as well as sa-testing b_1000852 to increase screening for colorectal cancer and mammogra 2. US Preventive Services Task Force: Procedure manual, AHRQ phy. This model encourages accountability at the commu 1b No 08-05118-EF, 2008, Agency for Healthcare Researd nity level for delivery of preventive services. Although there is little downside to increasing the use of vaccinations, com 3. US Preventive Services Task Force: Methods and process www.uspreventiv munity collaboration also is not without challenges: The 1/2/20l1 increase of screening rates through such programs likely 4. Guirguis-Blake ) Current processes of the U.S. Preventive Ser carries the same problems of overuse and misuse as can vices Task Force: refining evidence-based recommendation occur through a physicians office(see Chapter 16) development. Ann Intern Med 147: 117-121, 2007