Guide to Clinical Preventive Service

Summary of 2005 Recommendations of USPSTF for the AIM clinic 

 
SCREENING

(USPSTF grade) age

Additional info

High blood press.

(A)18 and over

 

Lipid Disorder

(A)-Female >45, Male >35

(B)-over 20 with CV risk factors

(B) test for tot.chol and HDL

(I) insuff. evidence for checking Tg

(C) for checking lipids in over 20 -35 without risk factors

DM/IFG

(B) pt with HTN/hyperlipidemia;

**ADA recommends screening high risk over 45 yrs old

ADA-over 45y.o. overweight/obese, of high
risk ethnic groups, with family history of diabetes, or with hx gestational DM or babies>9lbs

Cervical CA (pap)

(A) >21 or 3yrs after activity, over 65/TAH see below

(D) for over 65 with hx of nl. Pap.or s/p TAH

(I) for use of new technology incld HPV

Breast CA

(B) over 40 q1-2 yrs

(I) for clinical or self breast exam

Colorectal CA

(A) over 50

yrly FOBT, colonoscopy, etc…

Osteoporosis

(B) >65, for +RF >60

(C) for <60 and 60-64 not at incr. risk.

-rescreening interval  over 2 yrs

Depression

(B) screening

 

Alcohol

(B) screening and counseling

For all including pregnant women

Diet review teaching

(B) adults with dyslipid., other CV risk factors, diet related chronic dz

(I) diet counseling in unselected population

Obesity

(B) screening of all, and offer intens.counseling/behavioral mod

 

Tobacco

(A) for all incld pregnant women

Screening/counseling/ and treatment

ASA chemoproph.

(A) for “at risk” (?10 yr risk >6%)

75mg daily effective

Aortic aneurysm

(B) 65-75 male smokers

 

PPD

(A) high risk

 

Chlamydia/GC

<25 F or  high risk- chlm. (A) GC (B)

 

Dental

(B) counseling to visit regularly

From 1996 recommendation

Syphillis

(A) at risk population

(D) for asx not at risk pts

HIV

(A) high risk, or in high prevalence population

Being cared for in CPMC (??AIM) is considered to be high risk >1% prev.

Hep B infection screening

(A) pregnant women at first visit

(D) in general asx population

Rubella*

(A) high risk and all pregnant women

(D) for asx persons not at risk

Discuss breast ca chemoproph.

(B) high risk pt, need to balance risk vs. benefit

(D) for primary prevention for low or average risk

*other vaccinations see ADIP sheet     * OB recommendation are not included here

D - Not Recommended

§  Ovarian Ca

§  Bladder CA

§  testicular CA

§  pancreatic CA

§  use of vitamins to prevent CA or CV dz,

§  CAD screening (in low risk)

§  Hep C in asx. population

§  hormone therapy in postmenopausal

 

(I) insufficient evidence for or against

§  glaucoma

§  Hep C in hi risk population

§  CAD in high risk population

§  lung CA

§  Prostate CA
pancreatic CA

§  Oral CA

§  Skin CA

Insufficient (continued)

§  domestic violence/abuse

§  dementia in elderly

§  suicide risk in gen. pop.

§  Increase physical activity

§  Scoliosis in adolescent

§  Low back pain prevention counseling

 

Grade A- USPSTF strongly recommends with good evidence that service improves impt. health outcomes and concludes that benefits substantially outweighs harm. 

Grade B –USPSTF recommends to provide service to eligible pt, supported by at least fair evidence that service improves impt. Health outcomes and conclude and benefit outweighs harm.

Grade C-USPSTF makes no recommendation for or against. The USPSTF found at least fair evidence that service improves outcome, but conclude the balance of benefit and harm is too close to justify a general recommendation.

Grade D- USPSTF recommends against routinely providing service to asx patients. Found at least fair evidence that the services is ineffective or that harm outweigh benefits

Grade I- USPSTF conclude evidence is insufficient to recommend for or against routinely providing service. Evidence that the service is effective is lacking, or poor quality, or conflicting, and the balance of benefit and harms cannot be determined.

Reference: from the 2005 USPSTF Pocket Guide (click her to be linked into more information for each screening recommendation)