Monday, August 16, 2010

NEED YOUR IDEAS: US Preventive Services Task Force Topic Nominations

The US Preventive Services Task Force is soliciting nominations for clinical preventive health topics.  Nominations can be submitted by individuals or organizations.  I think it would be great to submit a GeriPal topic.  Can you think of Geriatrics and Palliative care issues in preventive terms?  There are recommendations for cancer screening in the elderly (mostly age based cutoffs), hearing and visual loss, but nothing about screening for chronic pain in the elderly (other than counseling for low back pain), falls, dementia, or advance care planning.  For a list of current recommendations for adults, click here.  Try and think of things that will spin the USPSTF in a very positive light.  After the disastrous press over mammography recommendations for women in their 40's last year, they're probably looking for topics that will play well with the public (or at the very least spin their topics better to the press).

The following details what the USPSTF is looking for in a nomination and their criteria for selection (from this page).

The USPSTF will first determine if the topic relates to a service is eligible, i.e., constitutes primary or secondary prevention applicable to healthy asymptomatic persons; is primary care-feasible or referable from primary care; and addresses a condition with a substantial health burden. As a second step, within eligible topics, the USPSTF will prioritize based on the following set of criteria: Public health importance (burden of suffering, potential of preventive service to reduce the burden); and potential for greatest Task Force impact (e.g., clinical controversy, practice does not reflect evidence, inappropriate timing in delivery of services).

Nominations must be less than 500 words and be in the following format:

1. Name of topic.
2. Rationale for consideration by the USPSTF, describing:
a. Characterization as primary or secondary prevention topic (screening, counseling or preventive education).
b. Primary care relevance (applicable clinical preventive service must be provided by a primary care provider and or initiated in the primary care setting which can be defined as family practice, internal medicine, pediatrics or obstetrics/gynecology).
c. Public health importance (burden of disease/suffering, potential of preventive service to reduce burden, including effective interventions). Citations and supporting documents are recommended.
d. Potential impact of USPSTF’s review of the topic, i.e., change in clinical practice, research focus, etc.

Please submit your ideas in the comments, and we'll see if we can come up with something worth submitting by the deadline, August 27th. 

by: Alex Smith

3 comments:

Eric Widera said...

In 2003 the USPSTF concluded that the evidence was "insufficient to recommend for or against routine screening for dementia in older adults". I doubt that they would take another look at this.

Falls would be great. There is a growing body of literature (see the latest JAMA Care of the Older patient series).

The other would be urinary incontinence. Its a big enough problem that I was suprised it wasnt in there. I guess hemochromatosis is a much bigger issue in the US...

Alex Smith said...

Good idea Eric. I just submitted a "prevention of falls." Submitted by the GeriPal community. Here's what I said:

Submitted by Alexander K. Smith, MD MS MPH
Assistant Professor of Medicine, UCSF aksmith@ucsf.edu
On behalf of the GeriPal (Geriatrics and Palliative Care) blogging community (www.GeriPal.org).

1. Name of topic: Falls prevention

2. Rationale for consideration by the USPSTF, describing:

a. Characterization as primary or secondary prevention topic (screening, counseling or preventive education).
This is both primary and secondary prevention. Clinicians should screen patients age 65 and older for fall risk who present with a fall, report at least 1 injurious fall or 2 or more noninjurious falls, or report or display unsteady gait or balance. Patient who display unsteady gait or balance are at risk for falling (primary prevention) and those who fell previously are at risk for falling again (secondary prevention). Elders who meet these criteria should undergo yearly fall risk factor assessment and management (1).
b. Primary care relevance
This topic is most relevant to internists and family practice physicians, who care for the vast majority of older adults in the US.
c. Public health importance
Over a third of community-dwelling elders falls every year. To quote a recent JAMA paper by Dr. Mary Tinetti and Dr. Chandrika Kumar, “Falls are major contributors to functional decline and health care utilization. Falling without a serious injury increases the risk of skilled nursing facility placement by 3-fold after accounting for cognitive, psychological, social, functional, and medical factors; serious fall injury increases the risk 10-fold. Falls and fall injuries are among the most common causes of decline in the ability to care for oneself and to participate in social and physical activities” (2).
Effective interventions to reduce fall risk are often multifactorial, including tailoring of medication (reducing or eliminating psychoactive medications), physical therapy, and home safety evaluation (2). Individuals at risk of falling often face trade-offs between safety and independence. Primary care providers are best positioned to address these issues with patients, and management strategies must be tailored to the individual goals and values of the patient.

d. Potential impact of USPSTF’s review of the topic.
Increased screening for falls and incorporation of falls prevention strategies may impact important health outcomes, such as function and symptoms, and reduce health care costs (2).

1. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc2001 May;49(5):664-72.
2. Tinetti ME, Kumar C. The patient who falls: "It's always a trade-off". JAMA Jan 20;303(3):258-66.

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