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Questions and Answers
Questions and answers about clinical preventive services and the U.S. Preventive Services Task Force (USPSTF).
The USPSTF is supported by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ), and is made up of doctors, nurses, and other health care professionals with expertise in family medicine, pediatrics, internal medicine, obstetrics and gynecology, geriatrics, preventive medicine, public health, behavioral medicine, and nursing. USPSTF members are experts in prevention, evidence-based medicine, and primary care. Recommendations made by the USPSTF are independent of the U.S. Government. The USPSTF has sole responsibility for reviewing the evidence and making recommendations about clinical preventive services. The USPSTF has no regulatory authority.
The USPSTF systematically reviews the evidence for prioritized clinical preventive services to determine the balance of benefits and harms for specific groups of people based on age, gender, and other risk factors for disease. Based on that evidence review, the USPSTF makes recommendations to primary care providers about which clinical preventive health care services to offer their patients and how often.
For the USPSTF to consider a preventive service to be effective, benefits must outweigh the harms. The USPSTF looks at several different types of harms, including direct physical harms such as harms from invasive procedures, and "downstream" harms, such as the risks of follow-up testing or of treatments. The USPSTF also considers excessive time or effort needed on the part of either the patient or the health care provider to be a burden of providing the service. For a detailed explanation of the USPSTF's methods, go to the USPSTF Procedure Manual at http://www.uspreventiveservicestaskforce.org/uspstf08/methods/procmanual.htm.
USPSTF recommendations are intended to improve the health of individuals and society by reducing the length of and need for medical treatment.
The USPSTF also regularly reviews the scientific evidence for its recommendations to determine whether they are still current. This review allows the USPSTF to find where evidence is missing and recommend areas of research for scientists who study clinical preventive medicine. Since its beginnings, the USPSTF has addressed nearly 70 preventive health topics. The USPSTF aims to update its recommendations at least every five years.
Clinical preventive services include:
- Screening tests, such as colonoscopy, mammography, or blood pressure measurement.
- Counseling, such as counseling to prevent tobacco use.
- Preventive medications, such as aspirin to reduce the likelihood of heart attack or stroke.
- Immunizations to prevent illnesses in infants, children, and adults, including pneumonia, flu, polio, and others.
Health care providers offer clinical preventive services to find or prevent specific medical conditions in patients who have no signs or symptoms of those conditions. These services are offered to patients who may develop a condition because of their lifestyle, age, gender, personal or family medical history, or a combination of these. Some preventive services are meant to catch diseases early, and others are meant to prevent diseases entirely.
The USPSTF recognizes the importance of immunizations in primary disease prevention. The USPSTF refers to recommendations made by the Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices for immunization of children and adults.
When the USPSTF completes its review of the scientific evidence on a particular preventive service, the group publishes a Recommendation Statement in a medical journal, such as Annals of Internal Medicine, or on the AHRQ Web site. The USPSTF Recommendation Statements present primary care providers, including doctors, nurses, and other clinicians who care for patients, with information about the evidence behind each recommendation so they can make informed decisions about how to use the recommendations in their practices.
The Recommendation Statement is accompanied by supporting documents that present the evidence in detail.
The foundation of the Recommendation Statement is the recommendations themselves. Each USPSTF recommendation is given a grade based on the strength of the evidence about the benefits and harms of the preventive service.
Suggestions for Practice
|The USPSTF recommends the service. There is high certainty that the net benefit is substantial.||Offer or provide this service.|
|The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.||Offer or provide this service.|
|Note: The following statement is undergoing revision.
Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service.
|Offer or provide this service only if there are other considerations in support of offering or providing the service to an individual patient.|
|The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.||Discourage the use of this service.|
|The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.||Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.|
In addition to the recommendations, Recommendation Statements include the USPSTF's reasoning for the recommendations, guidance for primary care providers who want to use the recommendations in their practices, and a discussion of the evidence. Each Statement also reports the recommendations of other professional groups, which may be different from those of the USPSTF.
Primary care providers, policymakers, Federal and State agencies, insurers, and other health care providers rely on USPSTF Recommendation Statements as decisionmaking resources. The USPSTF recommendations serve as clinical standards for many professional societies, health organizations, and medical quality review groups. They are used widely in undergraduate and post-graduate medical and nursing studies. However, the USPSTF has no regulatory authority.
All USPSTF Recommendation Statements are available on the USPSTF Web site at http://www.uspreventiveservicestaskforce.org. They are also published every year in the U.S. Preventive Services Task Force Guide to Clinical Preventive Services, available on the USPSTF Web site and in print from the AHRQ Publications Clearinghouse at AHRQpubs@ahrq.hhs.gov or toll-free at 800-358-9295. AHRQ's Electronic Preventive Services Selector (ePSS) can help primary care clinicians identify the clinical preventive services that are appropriate for their patients. The ePSS Web and mobile applications can be searched by specific patient characteristics, such as age, sex, and selected behavioral risk factors; this tool is available at http://epss.ahrq.gov.
The U.S. Preventive Services Task Force is an independent panel of non-Federal experts in prevention and primary care. The USPSTF was first assembled by the U.S. Public Health Service in 1984, and has been supported by AHRQ since 1998. Through the Public Health Service Act, AHRQ is authorized to convene the USPSTF to conduct scientific evidence reviews of a broad range of clinical preventive services and develop recommendations for the health care community. AHRQ provides administrative, research, technical, and dissemination support to the USPSTF.
In AHRQ's Evidence-Based Practice Center (EPC) program, EPCs develop, under contract, evidence reports and technology assessments on topics relevant to clinical, social science/behavioral, economic, and other health care organization and delivery issues. One of these EPCs works with the USPSTF and conducts systematic reviews of specified questions concerning the evidence on prioritized topics. These EPC evidence reports serve as the scientific basis for USPSTF recommendations.
The USPSTF Web site at http://www.uspreventiveservicestaskforce.org/uspstopics.htm lists all recommendations: active, inactive, and in progress.
Since 2001, the USPSTF has been a standing Task Force of 16 members, including a Chair and a Vice-Chair. Members are invited to serve for a 4-year term, with a possible 1- to 2-year extension. Each year, a notice is placed in the Federal Register soliciting nominations for USPSTF members to replace those who have completed their appointments. Anyone can submit a nomination; self-nominations also are accepted.
New members are selected by the Director of the Agency for Healthcare Research and Quality (AHRQ) in consultation with the USPSTF leadership. Members are chosen based on their qualifications and the current needs of the USPSTF for particular areas of expertise.
The 16 USPSTF members represent an array of experts in primary care and preventive health-related disciplines, including internal medicine, family medicine, behavioral medicine, pediatrics, obstetrics/gynecology, and nursing.
For a current list of members of the USPSTF and their affiliations, go to: http://www.uspreventiveservicestaskforce.org/about.htm#Members.
Go to http://www.uspreventiveservicestaskforce.org/tfcomment.htm for complete information on commenting on draft USPSTF Recommendations.
Current as of February 2011
Topic Nominations Helpful Information: Questions and Answers. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/tfnomqa.htm