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Putting Prevention into Practice (Short Form) Using the United States Preventive Services Task Force Recommendations.

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Presentation on theme: "Putting Prevention into Practice (Short Form) Using the United States Preventive Services Task Force Recommendations."— Presentation transcript:

1 Putting Prevention into Practice (Short Form) Using the United States Preventive Services Task Force Recommendations

2 Acknowledgements Robert M. Gum, DO, MPH, FACPM, Statewide Campus Regional Assistant Dean, WVSOM Robert M. Gum, DO, MPH, FACPM, Statewide Campus Regional Assistant Dean, WVSOM James F. Cawley, MPH, PA-C, Professor and Vice Chair, Department of Prevention and Community Health School of Public Health and Health Services The George Washington University James F. Cawley, MPH, PA-C, Professor and Vice Chair, Department of Prevention and Community Health School of Public Health and Health Services The George Washington University V. James Guillory, DO, MPH, FACPM, Professor of Public Health, Public Health Program, KUMC V. James Guillory, DO, MPH, FACPM, Professor of Public Health, Public Health Program, KUMC John C. Pellosie, Jr., D.O., MPH, FAOCOPM, Chair of Preventive Medicine, NSUCOM John C. Pellosie, Jr., D.O., MPH, FAOCOPM, Chair of Preventive Medicine, NSUCOM H.S. Teitelbaum, DO, PhD, MPH, Professor and Chair, Department of Preventive and Community Medicine, LMU-DCOM H.S. Teitelbaum, DO, PhD, MPH, Professor and Chair, Department of Preventive and Community Medicine, LMU-DCOM

3 Thoughts on Prevention "To find health should be the object of any doctor. Anyone can find disease.“ "To find health should be the object of any doctor. Anyone can find disease.“ –---Andrew Taylor Still, D.O. “Prevention is one of the few known ways to reduce demand for health and aged care services. “ “Prevention is one of the few known ways to reduce demand for health and aged care services. “ – ---Julie Bishop, JD “The purpose of risk assessment is not to categorize individuals according to a test result nor even as to their overall risk, but rather to identify those who can be helped, or helped most, by preventive action.” “The purpose of risk assessment is not to categorize individuals according to a test result nor even as to their overall risk, but rather to identify those who can be helped, or helped most, by preventive action.” –---Geoffrey Rose, MD, PhD

4 Objectives Encourage focus on prevention05 Encourage focus on prevention05 Identify basic health screening principles06 Identify basic health screening principles06 Discuss the role of evidence-based medicine07 Discuss the role of evidence-based medicine07 Define the USPSTF grading system08 Define the USPSTF grading system08 Implement wellness intervention 09 Implement wellness intervention 09 Discuss counseling and delivery to patients 10 Discuss counseling and delivery to patients 10 Describe new federal initiatives11 Describe new federal initiatives11 Demonstrate USPSTF-related Resources12-28 Demonstrate USPSTF-related Resources12-28 Slide #

5 Why Prevention? In prevention the goal is to preserve and promote health and well being In prevention the goal is to preserve and promote health and well being Prevention in public health moves interventions from the individual level to a population level Prevention in public health moves interventions from the individual level to a population level Effective prevention leads to a healthier community Effective prevention leads to a healthier community – Why Now? Federal support exists for prevention Federal support exists for prevention

6 Levels of Prevention Primary Prevention Primary Prevention  Avoidance/prevention of disease or injury (inclusive of mental health)  Immunizations Secondary Prevention Secondary Prevention  Early detection and treatment  Mammography Tertiary Prevention Tertiary Prevention  Reduction of disability and prompt rehabilitation  Management of existing conditions.  End-stage renal failure

7 The Role of Evidence Based Medicine The USPSTF reviews the scientific evidence regarding the effectiveness, risks, and benefits of specific health care services. The USPSTF reviews the scientific evidence regarding the effectiveness, risks, and benefits of specific health care services. A conclusion that there is no evidence of the effectiveness of a service is different from a conclusion that the service is ineffective. A conclusion that there is no evidence of the effectiveness of a service is different from a conclusion that the service is ineffective.

8 What the Grades Mean

9 Implementing Wellness Interventions Work interprofessionally Work interprofessionally Counsel patient effectively Counsel patient effectively Recognize the body is capable of self- healing and health maintenance Recognize the body is capable of self- healing and health maintenance Using the ePSS program saves time and simplifies the task. Using the ePSS program saves time and simplifies the task. Work with legislators to support wellness services Work with legislators to support wellness services

10 Counseling Strategies Tailor teaching to patients needs Tailor teaching to patients needs Purpose, effects and when to expect effects Purpose, effects and when to expect effects Suggest small changes Suggest small changes Use influence of profession Use influence of profession Encourage comments from patient Encourage comments from patient Combine strategies Combine strategies Involve office staff Involve office staff Monitor progress Monitor progress Be specific Be specific Add new behaviors rather than eliminate established behaviors Add new behaviors rather than eliminate established behaviors Link the new to old behaviors Link the new to old behaviors Listening Listening Assess readiness for change Assess readiness for change Cultural sensitivity Cultural sensitivity Community resources Community resources Refer appropriately Refer appropriately

11 New Federal Initiatives Change in Reimbursements Reimbursement for services has been an impediment to consistently providing preventive/wellness services in a busy clinic environment. Recent legislation has removed this barrier. Reimbursement for services has been an impediment to consistently providing preventive/wellness services in a busy clinic environment. Recent legislation has removed this barrier. Free Preventive Care Under Medicare—Eliminates co ‐ payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, Free Preventive Care Under Medicare—Eliminates co ‐ payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, Free Preventive Care Under New Private Plans—Requires new private plans to cover preventive services with no co ‐ payments and with preventive services being exempt from deductibles. Effective 6 months after enactment [9/23/10]. Free Preventive Care Under New Private Plans—Requires new private plans to cover preventive services with no co ‐ payments and with preventive services being exempt from deductibles. Effective 6 months after enactment [9/23/10]. New England Journal of Medicine, Promoting Prevention through the Affordable Care Act, /JEJM

12 Tools for Different Audiences Physicians and healthcare providers Physicians and healthcare providers  Electronic and print resources and tools  Downloadable point of care prompts – electronic Preventive Services Selector:  How to: Patients Patients  Explanation of recommendations  Checklists to monitor individual preventive needs  has tools for patients.

13 Download the ePSS

14 Using the ePSS in a clinical setting-an example: Patients are typically screened by a member of the health care team in initial portion of an encounter Patients are typically screened by a member of the health care team in initial portion of an encounter A nurse typically takes vital signs and measures the patient’s height and weight prior to seeing the provider A nurse typically takes vital signs and measures the patient’s height and weight prior to seeing the provider This provides an opportunity to complete a brief preventive medicine/wellness questionnaire This provides an opportunity to complete a brief preventive medicine/wellness questionnaire Print for inclusion in the health record or electronic review by the healthcare provider Print for inclusion in the health record or electronic review by the healthcare provider Reviewed by the healthcare provider Reviewed by the healthcare provider Concurs or changes recommendations Concurs or changes recommendations Brief discussion with the patient for those answers or findings that require treatment or need to be addressed with a comment that a member of the clinic staff will address some concerns in more detail Brief discussion with the patient for those answers or findings that require treatment or need to be addressed with a comment that a member of the clinic staff will address some concerns in more detail

15 Using the ePSS in a clinical setting-an example: Designated member of the health care team reviews in greater detail Designated member of the health care team reviews in greater detail Further counseling is provided by a member of the clinic staff Further counseling is provided by a member of the clinic staff Printed instructions should be provided to the patient for further reference and explanation of the healthcare team recommendations Printed instructions should be provided to the patient for further reference and explanation of the healthcare team recommendations The VA Model is a working example similar to what was just described. The VA Model is a working example similar to what was just described. A member of the healthcare team completes an in-depth screening using the VA electronic medical records system. The patient answers are documented for the healthcare provider’s review. A member of the healthcare team completes an in-depth screening using the VA electronic medical records system. The patient answers are documented for the healthcare provider’s review. The healthcare provider reviews the patient responses and addresses the health risks with the patient, recommending lifestyle modification and/or treatment The healthcare provider reviews the patient responses and addresses the health risks with the patient, recommending lifestyle modification and/or treatment When appropriate the patient returns to the nurse for further discussion and counseling. Referral is made as indicated to a specialist When appropriate the patient returns to the nurse for further discussion and counseling. Referral is made as indicated to a specialist

16 Case 1: Male, 57 y/o, smoker, sexually active

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18 Case 2: Male, 77 y/o, nonsmoker, sexually active

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20 Case 3: Male, 17 y/o, nonsmoker, sexually active

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22 Patient Case 1 Your physician assistant (PA) reports to you the story of a 45- year-old man seen in the practice for an annual examination. The patient’s only complaint is occasional elbow pain that he attributes to using a new tennis racquet. He reports no medical illnesses and his only prior surgery is a hernia repair 10 years ago. He takes one low-dose aspirin per day, does not smoke and reports having an occasional alcoholic beverage. He reports no family history of early heart disease or cancer. Last year, his total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were normal. He is married and in a monogamous relationship. Since testing negative for STIs (including HIV) many years ago, he reports no potential for new exposures. On examination, he is not overweight and not hypertensive. The patient asked the PA about the recommended preventive services for a person at his age and your PA is unsure of the appropriate source of prevention guidelines. Your physician assistant (PA) reports to you the story of a 45- year-old man seen in the practice for an annual examination. The patient’s only complaint is occasional elbow pain that he attributes to using a new tennis racquet. He reports no medical illnesses and his only prior surgery is a hernia repair 10 years ago. He takes one low-dose aspirin per day, does not smoke and reports having an occasional alcoholic beverage. He reports no family history of early heart disease or cancer. Last year, his total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were normal. He is married and in a monogamous relationship. Since testing negative for STIs (including HIV) many years ago, he reports no potential for new exposures. On examination, he is not overweight and not hypertensive. The patient asked the PA about the recommended preventive services for a person at his age and your PA is unsure of the appropriate source of prevention guidelines.

23 Patient Case 1

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25 Patient Case 2 A 40-year–old woman presents to your clinic for a periodic examination and its seen initially by the nurse practitioner (NP). The patient reports no medical illnesses and has had no prior surgeries. She does not smoke or drink any alcoholic beverages. Her paternal grandfather was a heavy smoker and died of lung cancer at age 65. Otherwise, she has no other family history of cancer. She is married and in a mutually monogamous relationship. A colleague at work was diagnosed with breast cancer 5 years before and since that time this patient has performed periodic self- breast examinations. She reports no changes in her breasts, but asks the NP if she should get a mammogram. The NP asks you about your interpretation of current USPSTF recommendations regarding screening mammography. A 40-year–old woman presents to your clinic for a periodic examination and its seen initially by the nurse practitioner (NP). The patient reports no medical illnesses and has had no prior surgeries. She does not smoke or drink any alcoholic beverages. Her paternal grandfather was a heavy smoker and died of lung cancer at age 65. Otherwise, she has no other family history of cancer. She is married and in a mutually monogamous relationship. A colleague at work was diagnosed with breast cancer 5 years before and since that time this patient has performed periodic self- breast examinations. She reports no changes in her breasts, but asks the NP if she should get a mammogram. The NP asks you about your interpretation of current USPSTF recommendations regarding screening mammography.

26 Patient Case 2

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28 For More Information If you have any questions or would like more information please contact: If you have any questions or would like more information please contact: – Barbara Kass, Health Communications Specialist, Office of Communications and Knowledge Transfer; AHRQ at Helpful URLs Helpful URLs – AHRQ’s USPSTF website (http://www.preventiveservices.ahrq.gov) has downloadable electronic Preventive Services Selector (ePSS) app – Printable patient counseling information for clinicians and patients, available at – Technical Assistance paper with patient cases for health professions education – PowerPoint slide deck for educators and clinicians: “Understanding the Methods Used by the USPSTF in Developing Recommendations”


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