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By Alfred O. Berg, M.D., M.P.H.,a,c and Janet D. Allan, Ph.D., R.N., C.S.b,c *
Address correspondence to: Alfred O. Berg, M.D., M.P.H., Chair, USPSTF, Professor and Chair, Department of Family Medicine, University of Washington School of Medicine, 1959 Northeast Pacific Avenue, Box 356390, Seattle, WA 98195
This article originally appeared in the American Journal of Preventive Medicine. Select for copyright and source information.
Providing preventive services to apparently healthy individuals in clinical settings is such a ubiquitous part of primary care practice that it is easy to forget that the concept is less than 100 years old. The idea that clinicians had anything useful to offer healthy people was a product of the 1930s and 1940s, during an era of rapid advances in public health and progress in the pathophysiologic view of disease. Claims that patients could benefit from "periodic health examinations" were initially met with skepticism on the part of most medical practitioners. But the skeptics were quickly converted, so that by the 1950s and 1960s the proliferation of screening tests and primary preventive advice was far advanced in routine clinical practice. Many clinical conditions for which diagnostic tests were available became targets for inclusion in periodic examinations, at one extreme resulting in programs of excess in which healthy individuals of means might be admitted to hospital to undergo a battery of screening and diagnostic testing over several days.
Despite the quick and general acceptance of screening as a component of routine clinical practice, a few advocates for studies to test directly the efficacy of screening tests and other preventive interventions raised concerns about the lack of evidence that interventions truly improved clinical outcomes. These concerns became organized during the 1970s when critical scientific reviews were first published by individuals and expert groups. Since the 1980s, both the Canadian Task Force on Preventive Health Care and the United States Preventive Services Task Force (Task Force) have provided evidence-based scientific reviews of preventive health services for use in primary care clinical settings, including screening tests, counseling, and chemoprevention. The first Task Force Guide to Clinical Preventive Services (1) was published in 1989. The second Task Force Guide to Clinical Preventive Services (2) was published in 1996 and served as the basis for the 1998 Clinicians Handbook of Preventive Services (3) and the Put Prevention Into Practice national implementation program.
What was originally published as a supplement to the American Journal of Preventive Medicine (AJPM) introduces the methods and products of the third Task Force. The first background article (4) reviews the philosophy and history of Task Force work, placing our new efforts in historical perspective, discussing challenges faced by the Task Force, and previewing several of the contributions to be made. The second background article (5) summarizes the methods used by the Task Force, its extraordinary length appropriately reflecting the importance we place on public accountability and transparency of the methods used to reach our conclusions. Despite its length, the article cannot fully describe all the details; these will be presented in more depth in each of the Systematic Evidence Reviews that will be published on the AHRQ Web site and in print. The third background article (6) covers one of the significant new additions to the scope of work of the third Task Force: economic evaluation. For the first time, when evaluating preventive interventions, we are attempting to answer not only the question "Does it work?" (the scientific assessment of efficacy), but, for selected conditions, "Is it worth it?" (the assessment of economic benefits and costs).
Following the background articles are four pairs of recommendation and rationale statements (produced principally by Task Force members and staff) (7,8,9,10) and evidence summaries (produced principally by the Evidence-based Practice Centers at the Oregon Health Sciences University and Research Triangle Institute-University of North Carolina) (11,12,13,14). These recommendation and rationale statements, evidence summaries, and the Systematic Evidence Reviews are available at the U.S. Preventive Services Task Force Web site (www.ahrq.gov/clinic/uspstfix.htm). We also hope to see many of the recommendation and rationale statements published in a variety of peer-reviewed and continuing education journals to reach a broad range of health professionals. The Systematic Evidence Reviews will be used to generate individual papers in the peer-reviewed literature highlighting key meta-analyses, modeling projects, and other work conducted as part of the review process used by the Task Force.
Finally, several commentators (15,16,17) provide advice on how to use the information provided in the supplement. We believe that our readers of AJPM, most of whom share our interest, concern, and passion for preventive health care, will appreciate the articles in this "launch" of the work of the third Task Force.
References and Notes
1. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 1st ed. Washington, DC: Office of Disease Prevention and Health Promotion, 1989.
2. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd ed. Washington, DC: Office of Disease Prevention and Health Promotion, U.S. Government Printing Office, 1996.
3. U.S. Preventive Services Task Force Put Prevention Into Practice. Clinician's Handbook of Preventive Services, 2nd ed. (Available from the Agency for Healthcare Research and Quality, Pub. No. APPIP 98-0025). Washington, DC: Office of Disease Prevention and Health Promotion, 1996.
4. Woolf SH, Atkins D. The evolving role of prevention in health care: contributions of the U.S. Preventive Services Task Force. Am J Prev Med 2001;20(suppl 3):13-20.
5. Harris RP, Helfand M, Woolf SH, et al., for the Methods Work Group, third U.S. Preventive Services Task Force. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20(suppl 3):21-35.
6. Saha S, Hoerger TJ, Pignone MP, Teutsch SM, Helfand M, Mandelblatt JS for the Cost Work Group of the third U.S. Preventive Services Task Force. The art and science of incorporating cost effectiveness into evidence-based recommendations for clinical preventive services. Am J Prev Med 2001;20(suppl 3):36-43.
7. U.S. Preventive Services Task Force. Screening for skin cancer: recommendations and rationale. Am J Prev Med 2001;20(suppl 3):44-6.
8. U.S. Preventive Services Task Force. Screening for bacterial vaginosis in pregnancy: recommendations and rationale. Am J Prev Med 2001;20(suppl 3):59-61.
9. U.S. Preventive Services Task Force. Screening adults for lipid disorders: recommendations and rationale. Am J Prev Med 2001;20(suppl 3):73-6.
10. U.S. Preventive Services Task Force. Screening for chlamydial infection: recommendations and rationale. Am J Prev Med 2001;20(suppl 3):90-4.
11. Helfand M, Mahon SM, Eden KB, Frame PS, Orleans CT. Screening for skin cancer. Am J Prev Med 2001;20(suppl 3):47-58.
12. Guise J-M, Mahon SM, Aickin M, Helfand M, Peipert JF, Westhoff C. Screening for bacterial vaginosis in pregnancy. Am J Prev Med 2001;20(suppl 3):62-72.
13. Pignone MP, Phillips CJ, Atkins D, Teutsch SM, Mulrow CD, Lohr KN. Screening and treating adults for lipid disorders. Am J Prev Med 2001;20(suppl 3):77-89.
14. Nelson HD, Helfand M. Screening for chlamydial infection. Am J Prev Med 2001;20(suppl 3):95-107.
15. Feightner JW, Lawrence RS. Evidence-based prevention and international collaboration. Am J Prev Med 2001;20(suppl 3):5-6.
16. Calonge N. New USPSTF Guidelines: integrating into clinical practice. Am J Prev Med 2001;20(suppl 3):7-9.
17. Russell LB. The methodologic partnership of effectiveness reviews and cost-effectiveness analysis. Am J Prev Med 2001;20(suppl 3):10-2.
Author Affiliations and Notes
[a] Berg: Department of Family Medicine, University of Washington School of Medicine, Seattle, WA.
[b] Allan: United States Preventive Services Task Force, San Antonio, TX.
[c] Berg and Allan: School of Nursing, University of Texas Health Science Center San Antonio, TX.
* Dr. Berg is Chair and Dr. Allan is Vice-Chair of the U.S. Preventive Services Task Force.
Copyright and Source Information
This document is in the public domain within the United States as stated in AHRQ's license agreement with the American Journal of Preventive Medicine. For information on reprinting, contact Randie Siegel, Director, Division of Printing and Electronic Publishing, Agency for Healthcare Research and Quality, Suite 501, 2101 East Jefferson Street, Rockville, MD 20852. Requests for linking or to incorporate content in electronic resources should be sent to: https://info.ahrq.gov.
Source: Berg AO and Allan JD. Introducing the Third U.S. Preventive Services Task Force. Am J Prev Med 2001;20(3S):3-4 (http://www.elsevier.com/locate/ajpmonline).