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Expert Recommendations

Key Issues and Related Recommendations from National Expert Panels

A firm grounding in science was one of the key guiding principles of the reports that are included in this Web site.  To that end, select recommendations related to relevant report indicators are provided from two national expert panels, the U.S. Preventive Services Task Force (USPSTF)† and the Task Force on Community Preventive Services‡.  For recommendations regarding immunization of children and adults, the USPSTF defers to the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP)§. Recommendations focus on the adult and older adult population, not school-aged children, given the purpose of this Web site.

Table A. Recommendations Related to Screenings and Risk Factors

 IndicatorU.S. Preventive Services Task Force(1)Task Force on Community Preventive Services(2)
SCREENINGSMammogram within past two years
  • Recommends biennial screening mammography for women aged 50 to 74 years. (2009; Grade: B)
  • Recommends interventions that include one-on-one education to encourage individuals to be screened for cancer. (2010)
  • Recommends the use of client reminder systems (2010)
  • Recommends interventions that reduce structural barriers such as distance from screening location, limited hours of operation, no daycare for children, and language and cultural factors. (2010)
  • Recommends interventions that reduce out-of-pocket costs to clients, such as those that reduce the costs of the screening tests, provide vouchers, reimburse clients or clinics, and/or reduce health insurance costs. (2009)
  • Recommends the use of “small media,” such as newsletters, video, and brochures. (2005)
Pap test within past three years
  • Recommends screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years or, for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years. (2012; Grade: A)
    NOTE: Recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion (i.e., cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer. (Grade: D)
  • Recommends interventions that include one-on-one education to encourage individuals to be screened for cancer. (2010)
  • Recommends the use of client reminder systems (2010)
  • Recommends the use of “small media,” such as newsletters, video, and brochures. (2005)
Colorectal cancer screening
  • Recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy, beginning at age 50 years and continuing until age 75 years. (2008; Grade: A)
  • Recommends interventions that include one-on-one education to encourage individuals to be screened for cancer. (2010)
  • Recommends the use of client reminder systems (2010)
  • Recommends interventions that reduce structural barriers such as distance from screening location, limited hours of operation, no daycare for children, and language and cultural factors. (2010)
  • Recommends the use of “small media,” such as newsletters, video, and brochures. (2005)
Cholesterol checked within past 5 years
  • Men: Recommends screening men aged 35 years and older and for lipid disorders. (2008; Grade: A)
  • Women: Recommends screening women aged 45 years and older for lipid disorders if they are at increased risk for coronary heart disease. (2008; Grade: A)
  • No applicable recommendations
Osteoporosis screening
  • Men: Current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men. (2011, Grade: I)
  • Women: Recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. (2011; Grade: B)
  • No applicable recommendations
Smoking cessation counseling
  • Recommends that clinicians screen all adults for tobacco use and provide cessation interventions for those who use tobacco products (2009; Grade: A)
  • Recommends provider reminders alone and with provider education systems for tobacco cessation, which includes efforts to identify clients who use tobacco products and to prompt providers to discuss and/or to advise clients about quitting. (2000)
Diabetes screening
  • Recommends screening for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg. (2008, Grade: B)
  • Current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in asymptomatic adults with blood pressure of 135/80 mm Hg or lower. (2008, Grade: I)
  • No applicable recommendations (current recommendations focus on diabetes management.)
RISK FACTORSNo leisure-time physical activity within past month
  • Although the correlation among healthful diet, physical activity, and the incidence of cardiovascular disease is strong, existing evidence indicates that the health benefit of initiating behavioral counseling in the primary care setting to promote a healthful diet and physical activity is small. Clinicians may choose to selectively counsel patients rather than incorporate counseling into the care of all adults in the general population. (2012, Grade: C)
  • Recommends community-wide campaigns to increase physical activity. (2001)
  • Recommends individually-adapted health behavior change programs to increase physical activity by teaching skills to help participants incorporate physical activity into their daily routines. The programs are tailored to each individual’s specific interests, preferences, and readiness for change. (2001)
  • Recommends social support interventions that focus on changing physical activity behavior through building, strengthening, and maintaining social networks that provide supportive relationships for behavior change. (2001)
  • Recommends community scale and urban design land use policies that address safety aspects of the physical environment; proximity of residential areas to commercial, educational, and recreational areas; and the connectivity of sidewalks and streets. (2004)
  • Recommends the creation of or enhancing access to places for physical activity, involving worksites, coalitions, agencies, and communities. Changes may include creating walking trails, building exercise facilities, or providing access to existing nearby facilities. (2001)
  • Recommends street-scale urban design and land use policies that involve the efforts of urban planners, architects, engineers, developers, and public health professionals to change the physical environment of small geographic areas, generally limited to a few blocks, in ways that support physical activity. (2004)
  • Recommends point-of-decision prompts to encourage the use of stairs. (2005)
Current Smoking
  • Recommends that clinicians screen all adults for tobacco use and provide cessation interventions for those who use tobacco products (2009; Grade: A)
  • Recommends increasing the unit price of tobacco products. (1999)
  • Recommends mass media campaigns when combined with other interventions. (2009)
  • Recommends mobile phone-based interventions. (2011)
  • Recommends provider reminders alone and with provider education systems for tobacco cessation, which includes efforts to identify clients who use tobacco products and to prompt providers to discuss and/or to advise clients about quitting. (2000)
  • Recommends reducing out of pocket costs for evidence-based cessation treatments. (2012)
  • Recommends multi-component interventions that include telephone support. (2000)
  • Recommends implementing smoke-free policies to reduce tobacco use among workers, and providing incentives and competitions to increase smoking cessation when combined with additional interventions. (2005)
Binge drinking within past 30 days
  • Recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults in primary care (2004; Grade: B)
    NOTE: Update in progress
  • Recommends electronic screening and brief interventions to reduce excessive alcohol consumption. (2012)
Obesity
  • Recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions (2012; Grade: B)
  • Recommends programs intended to improve diet and/or physical activity behaviors at worksites based on strong evidence of their effectiveness for reducing weight among employees. (2007)
  • Recommends behavioral interventions that reduce screen time by limiting time spent playing video or computer games, surfing the internet, and/or watching TV, videotapes, or DVDs. (2008)
  • Recommends multi-component coaching or counseling interventions to encourage and maintain weight loss. (2009)
High blood pressure ever
  • Recommends screening for high blood pressure in adults aged 18 and older (2007; Grade: A)
  • Recommends team-based care to improve blood pressure control. (2012)
Moderate depressive symptoms, Current Depression, Lifetime Diagnosis of Depression
  • Recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up. (2009; Grade: B)
  • Recommends mental health benefits legislation. (2012)
  • Recommends home- and clinic-based depression care management. (2008)
  • Recommends collaborative care for the management of depressive symptoms. (2010)
Injury, Mobility, and Bone HealthFall with injury within past year
  • Recommends exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls. (2012; Grade B)
  • Does not recommend automatically performing an in-depth multifactorial risk assessment in conjunction with comprehensive management of identified risks to prevent falls in community-dwelling adults aged 65 years or older because the likelihood of benefit is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of the circumstances of prior falls, comorbid medical conditions, and patient values. (2012; Grade: C)
  • No applicable recommendations.

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Table B. Recommendations Related to Immunizations

 IssueAdvisory Committee on Immunization Practices(3)Task Force on Community Preventive Services(2)
IMMUNIZATIONSInfluenza vaccine in past year
  • Recommends routine, annual vaccination for influenza for all people aged ≥6 months.
  • Recommends healthcare systems-based interventions implemented in combination. (2002)
  • Recommends provider reminders when used alone. (2001)
  • Recommends interventions with on-site, reduced cost, actively promoted vaccinations to enhance uptake of influenza vaccines among healthcare and non-healthcare workers. (2008)
Ever had pneumonia vaccine
  • Recommends persons aged 19--64 years who have asthma should receive a single dose of PPSV23.
  • Recommends that adults aged 19--64 years who smoke cigarettes should receive a single dose of PPSV23 and smoking cessation guidance.
  • Recommends the use of PPSV23 among American Indians and Alaska Natives aged <65 years if they are living in areas where the risk for invasive pneumococcal disease is increased.
  • Recommends all persons should be vaccinated with PPSV23 at age 65 years. Those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose. Those who receive PPSV23 at or after age 65 years should receive only a single dose.
  • Recommends multiple interventions implemented in combination (2002)
  • Recommends provider reminders when used alone. (2001)

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† Public Law 915 charges AHRQ to oversee the US Preventive Services Task Force (USPSTF), an independent panel of private sector experts on prevention and primary care, to conduct an impartial assessment of the scientific evidence for effectiveness of a broad range of clinical preventive services. The USPSTF evaluates the benefits of incorporating Clinical Preventive Services in routine primary medical care for individual services based on age, gender, and risk factors. The Task Force grades the strength of the evidence for delivery in clinical settings from A, strongly recommend, to I, insufficient evidence to recommend. Results are published in The Guide to Clinical Preventive Services.

‡The Task Force on Community Preventive Services is an independent, nongovernmental, volunteer body of public health and prevention experts, whose members are appointed by the Director of CDC. Its role is to oversee systematic reviews led by CDC scientists, carefully consider and summarize results, recommend interventions that promote population health, and identify areas for more research. Summaries of these reviews, published in The Guide to Community Preventive Services, share what is known about the effectiveness, economic efficiency, and feasibility of interventions to promote community health and prevent disease. For the purposes of this report, only recommendations that are directly related to delivery of services at the community level were included in the chart.

§ The Advisory Committee on Immunization Practices (ACIP) consists of immunization experts who have been selected by the Secretary of the U.S. Department of Health and Human Services. The Committee provides advice and guidance to the Secretary, the Assistant Secretary for Health, and the Centers for Disease Control and Prevention on the control of vaccine-preventable diseases. The Committee develops written recommendations for the routine administration of vaccines to children and adults in the civilian population, including age for vaccine administration, number of doses and dosing interval, and precautions and contraindications. The ACIP is the only entity in the federal government that makes such recommendations. For more information, visit the ACIP website.

References

  1. U.S. Preventive Services Task Force. USPSTF A and B Recommendations Web site. http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm.  Accessed July 17, 2013.
  2. Guide to Community Preventive Services. The Findings of the Task Force on Community Preventive Services Web site. http://www.thecommunityguide.org/about/conclusionreport.html. Accessed July 17, 2013.
  3. Centers for Disease Control and Prevention. Recommendations and Guidelines: Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention ACIP Web site. http://www.cdc.gov/vaccines/acip/index.html. Accessed July 17, 2013.

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