Posted 11/14/11 on Common Sense Family Doctor
Based in part on a positive recommendation from the U.S. Preventive Services Task Force, the Centers for Medicare and Medicaid Services recently announced that it will cover annual depression screenings for Medicare patients in primary care settings “that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment and follow-up.” However, as the below Figure illustrates, translating the USPSTF guideline into practice has been challenging for many primary care physicians.
A Policy One-Pager from researchers at the Robert Graham Center, published in the November 1st issue of American Family Physician, details the obstacles that clinicians face in identifying and treating depression and other mental health problems. As Dr. Robert Phillips and colleagues observe, “Current health care policy makes it difficult for most primary care practices to integrate mental health staff because of insufficient reimbursement, mental health insurance carve-outs, and difficulty of supporting colocated mental health professionals, to name a few.”
On a related note, an editorial in the same issue discusses strategies for improving adult immunization rates, which have historically lagged far behind rates of immunizations in children. According to Dr. Alicia Appel, immunization registries and electronic clinical decision-support systems can complement low-tech interventions such as patient reminders and standing orders. Clinicians, what has been your experience with incorporating depression screening and immunizations into routine health care for adults?
Kenny Lin is a family physician practicing in the DC area. He writes at Common Sense Family Doctor.
First published 8/1/11 on Common Sense Family Doctor
Below is the text of a proposed resolution that will be submitted by the District of Columbia Academy of Family Physicians to next month’s Congress of Delegates of the American Academy of Family Physicians in Orlando, Florida.
WHEREAS family physicians rely on current, unbiased sources of evidence-based guidelines to select appropriate screening tests and counseling services for their patients;
WHEREAS the primary source of evidence-based prevention guidelines for family physicians is the federally-sponsored U.S. Preventive Services Task Force (USPSTF), whose recommendation statements commonly serve as the basis for AAFP clinical policies on preventive services;
Continue reading “Politics in Service of Public Health”
First published 6/23/11 on the American Family Physician Community Blog
In 2002, the U.S. Preventive Services Task Force (USPSTF) strongly recommended that primary care clinicians discuss preventive aspirin use with adults at increased risk of cardiovascular events. Four years later, the National Commission on Prevention Priorities (NCPP) ranked counseling for aspirin use the number one priority on its list of the most effective clinical preventive services. According to the NCPP, if the percentage of eligible patients using aspirin (then estimated to be about 50 percent) increased to 90 percent, 45,000 additional lives could be extended each year.
At that time, the benefits of aspirin use in men and women were assumed to be the same. However, an updated USPSTF recommendation statement published in the June 15th issue ofAmerican Family Physician indicates that aspirin use actually prevents heart attacks in men, but ischemic strokes in women. In addition, physicians and patients must weigh the benefits of reduced cardiovascular risk with the risk of gastrointestinal bleeding events, and use shared decision making when these risks are closely balanced.
Continue reading “Aspirin for Primary CVD Prevention: The Continuing Debate”
First published 6/7/11 on Common Sense Family Doctor
Nearly forty years ago, President Richard Nixon famously declared a “War on Cancer” by signing the National Cancer Act of 1971. Like the Manhattan Project, the Apollo program that was then landing men on the Moon, and the ongoing (and eventually successful) World Health Organization-led initiative to eradicate smallpox from the face of the Earth, the “War on Cancer” was envisioned as a massive, all-out research and treatment effort. We would bomb cancer in submission with powerful regimens of chemotherapy, experts promised, or, failing that, we would invest in early detection of cancers so that they could be more easily cured at earlier stages.
It was in the spirit of the latter that the National Cancer Institute launched the Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) Screening trial in 1992. This massive study, which eventually enrolled more than 150,000 men and women between age 55 and 74, was designed to test the widespread belief that screening and early detection of the most common cancers could improve morbidity and mortality in the long term. Not a few influential voices suggested that the many millions of dollars invested in running the trial might be better spent on programs to increase the use of these obviously-effective tests in clinical practice.
They were wrong. As of this week, the PLCO study is 0-for-2.
Continue reading “No Easy Victories in Cancer Screening & Prevention”