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Clinical Preventive Services

Context & Benefits

Presenter:

Steven Teutsch, M.D., M.P.H., Senior Director, Outcomes Research Management, Merck & Co., Inc., Member, U.S. Preventive Services Task Force.


Current evidence concerning the effectiveness of preventive services shows that there is great potential for clinical and community-based prevention efforts to address the Nation's most costly health problems. However, preventive care is extremely underutilized in clinical settings.

Dr. Teutsch outlined the barriers that limit the appropriate use of these clinical preventive services and described how the use of quantitative, priority-setting mechanisms can identify opportunities to increase the provision of effective preventive care, including:

  • Lack of an evidence-based practice system for providers.
  • Lack of time by physicians to deliver preventive services.
  • Lack of incentive for physicians or health plans to provide such care.
  • Costs to health plan.
  • Limited patient demand.
  • Lack of knowledge about prevention by patients.

Because physicians average only 7 minutes per patient per clinical visit, they need a way to prioritize the clinical preventive service options available to them. To do this, an evidence-based framework needs to be developed within which effective clinical preventive services are identified and recommendations concerning their use can be made.

Given a constrained set of resources, cost-effectiveness must also be taken into account in prioritizing interventions. Reluctance on the part of healthcare workers to evaluate health outcomes in economic terms has made decisionmaking and prioritization extremely difficult.

The goal of policymakers should be to support the assessment of individual clinical interventions, as well as overall prevention strategies, and the provision of such evidence to healthcare providers and consumers in a usable, understandable format.

In addition, Federal and State governments can play a leadership role by measuring the outcomes of preventive services in terms of quality and effectiveness and promoting the delivery of services that work. Public sector initiatives can create incentives for action by healthcare systems by including performance measures in their Medicaid contracts and by relying on financial incentives to ensure the target goals are attained.

References

Haddix A, et al. Prevention effectiveness: a guide to decision analysis and economic evaluation. New York: Oxford University Press. 1996.

Teutsch SM, and Murray JF. Dissecting cost effectiveness analysis for preventive interventions: a guide for decision makers. Am J Man Care 1999;5:305-7.

Truman BI, Smith-Aiken CK, et al. Developing the Guide to Community Preventive Services—overview and rationale. Am J Prev Med 2000;18(1S):18-26.

U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd Edition, 1996.


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