This slidedeck is submitted by Zafar Hasan because one of the trends in medicine for the last 20 years isa focus on prevention and this deck is an outstanding practice primer.

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
 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
 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

3. Thoughts on Prevention
 "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. “
– ---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.”
– ---Geoffrey Rose, MD, PhD

4. Objectives
Slide #
 Encourage focus on prevention 05
 Identify basic health screening principles 06
 Discuss the role of evidence-based medicine 07
 Define the USPSTF grading system 08
 Implement wellness intervention 09
 Discuss counseling and delivery to patients 10
 Describe new federal initiatives 11
 Demonstrate USPSTF-related Resources 12-28

5. Why Prevention?
 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
 Effective prevention leads to a healthier
community
– Why Now?
 Federal support exists for prevention

6. Levels of Prevention
 Primary Prevention
 Avoidance/prevention of disease or injury
(inclusive of mental health)
 Immunizations
 Secondary Prevention
 Early detection and treatment
 Mammography
 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.
 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
 Counsel patient effectively
 Recognize the body is capable of self-
healing and health maintenance
 Using the ePSS program saves time and
simplifies the task.
 Work with legislators to support wellness
services

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

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.
 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, 2011.
 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, 10.1056/JEJM1008560

12. Tools for Different Audiences
 Physicians and healthcare providers
 Electronic and print resources and tools
 Downloadable point of care prompts –
electronic Preventive Services Selector:
www.epss.ahrq.gov
 How to: www.uspreventiveservicestaskforce.org
 Patients
 Explanation of recommendations
 Checklists to monitor individual preventive needs
 www.healthfinder.gov 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
• 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
• Print for inclusion in the health record or electronic review
by the healthcare provider
• Reviewed by the healthcare provider
• 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

15. Using the ePSS in a clinical
setting-an example:
• Designated member of the health care team reviews in greater
detail
• 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
• 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.
• 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

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

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

18. y/o, nonsmoker, sexually
active

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

20. y/o, nonsmoker, sexually
active

21. y/o, nonsmoker, sexually
active

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.

23. Patient Case 1

24. Patient Case 1

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.

26. Patient Case 2

27. Patient Case 2

28. For More Information
 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
barbara.kass@ahrq.hhs.gov
 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 http://epss.ahrq.gov/ePSS/Tools.do
– Technical Assistance paper with patient cases for health
professions education
http://www.ahrq.gov/qual/kt/tfmethods/impuspstf.htm
– PowerPoint slide deck for educators and clinicians:
―Understanding the Methods Used by the USPSTF in
Developing Recommendations‖
http://www.ahrq.gov/qual/kt/tfmethods/tfmethods.htm