Preventive Services I

Role of resources
Tests are expensive and the decision to go ahead with an insurance backed or government backed screening program often looks at the cost of the test. The cost per quality adjusted life year or QALY is often a factor in utilizing preventive services. Cost should consider not only the cost of the initial test, but the subsequent office visits, specialty referrals, additional testing, false positives, complications, and cost of treatment.

Evidence
The US Preventative Services Task Force is an example of a group that analyzes scientific evidence about the effectiveness of screening protocols, tests, and treatments. This group evaluates studies based on their design, methodological shortcomings, etc, and determines whether a study provides "fair", "good", or "excellent" support of their conclusion.

Values in Making Recommendations

 * People's biases affect their recommendations.
 * Test may be run for medical-legal reasons rather than scientific evidence, for example.
 * Different doctors offer conflicting recommendations.
 * Communication skills play a role
 * Patients have different health-belief models/values that effects decision making

Describe the factors that contribute to an effective screening test.
Source: Chapter 7: Clinical Prevention by Anthony Jerant.
 * 1) Test for a disease condition that subsequently develops into a substantial morbidity or mortality.
 * 2) High sensitivity, specificity of test
 * 3) High prevalence in population tested
 * 4) Disease should have asymptomatic period in which it can be detected (evidence should address lead time and length time baises)
 * 5) Treatments for the condition should be widely accepted and widely available
 * 6) Cost effective test & program
 * 7) Screening program should be safe and acceptable to patients & society (ie not too invasive or risky)

Describe these factors for set of preventive service in the prison population.
....the rest is up for interpretation.
 * 1) State run, state financed
 * 2) Could be compulsatory

Demonstrate application of knowledge gained to arrive at a group recommendation in a simulated advisory committee setting.
please refer to your personal experience...

Describe the method the USPSTF uses to create its recommendations, and define the categories of recommendation.

 * In contrast to recommendations from societies or medical professional groups, the recommendations of the USPSTF are not tied to an explicit political agenda or awareness campaign.
 * Evidence-based review of literature (meta reviews).
 * The Task Force makes its recommendations on the basis of explicit criteria. Recommendations issued by the USPSTF are intended for use in the primary care setting. The USPSTF recommendation statements present health care providers with information about the evidence behind each recommendation, allowing clinicians to make informed decisions about implementation.*


 * The USPSTF conducts systematic reviews of the evidence on specific topics in clinical prevention that serve as the scientific basis for USPSTF recommendations.


 * The USPSTF reviews the evidence, estimates the magnitude of benefits and harms for each preventive service, reaches consensus about the net benefit for each preventive service, and issues a recommendation.


 * The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against), or "I" (insufficient evidence to recommend for or against).


 * See USPSTF fact sheet for more info