PAUL F. SWENSON, MD, El Rio Community Health Center, Tucson, Arizona
MARK H. EBELL, MD, MS, University of Georgia College of Public Health, Athens, Georgia
Am Fam Physician. 2016;93(9):738-740
The U.S. Preventive Services Task Force (USPSTF) is an independent voluntary panel of experts in primary care, prevention, and evidence-based practice. As of April 2016, the USPSTF has recommendation statements for more than 80 active topics, most of which are endorsed by the American Academy of Family Physicians. 1 Its process has been recognized by the Institute of Medicine as a model for development of evidence-based practice guidelines. 2
However, numerous barriers exist to implementing these guidelines, including knowledge, time, insurance, and social barriers. 3 For example, knowledge of USPSTF colorectal cancer screening components ranged from 22% to 53% in first- through third-year medical residents. 4 One recent survey from the Centers for Disease Control and Prevention (CDC) found significant gaps in physicians' knowledge regarding the value of screening tests for ovarian and colorectal cancer. 5 Another survey found significant levels of nonadherence to USPSTF recommendations, including beginning cervical cancer screening too early, continuing it too long, and performing it annually rather than every three years as recommended. 6
In addition, recommendations for behavioral counseling are often not implemented. For example, counseling for tobacco cessation was documented in only 21% of visits in which tobacco use was documented. 7 This gap between guideline recommendations and actual practice has the potential to worsen as recommendations become more complex, vary by age group, and increasingly require risk assessment, as with recommendations for mammography, breast cancer chemoprevention, screening for the BRCA gene mutation, and screening for hepatitis B and C virus infections.
With the passage of the Affordable Care Act in 2010, the USPSTF guidelines have taken on new significance. Specifically, grade A and B recommendations must be covered without cost-sharing requirements for patients in nongrandfathered insurance plans. 8 Currently, several resources are available to help physicians understand and implement recommendations:
Although these resources are helpful, there has been no concise visual representation of USPSTF recommendations as there is for immunization recommendations (http://www.cdc.gov/vaccines/schedules/hcp/adult.html#print). The goals of such a schedule are the following:
The Adult Preventive Health Care Schedule meets these criteria. Although it is not everything a family physician needs to know about screening and prevention, it provides a practical clinical aid. We hope this helps physicians bridge some of the knowledge gaps of USPSTF recommendations and apply them to their practice.
editor's note: The authors will periodically update the online version of this table and supporting documents throughout the year to make it as current a resource as possible. We plan to run an updated version of this table once a year, similar to the annual immunization schedules. In the online PDF, note that there are links in the main table's risk factors to mini-tables showing what those risk factors are.
Dr. Ebell is Deputy Editor for Evidence-Based Medicine for AFP, and a member of the USPSTF. This editorial and accompanying figure were produced independently of the USPSTF and do not necessarily represent the views and policies of the USPSTF.
Dr. Swenson developed the original version of the preventive schedule with coauthors Coya Lindberg, Cynthia Carillo, MD, and Joshua Clutter, MD, as a resident at the University of Arizona.
Address correspondence to Paul F. Swenson, MD, at paul.swenson@gmail.com. Reprints are not available from the authors.
Author disclosure: No relevant financial affiliations.