USPSTF Perspective on Evidence-Based Preventive Recommendations for Children

Abstract

The development and use of evidence-based recommendations for preventive care by primary care providers caring for children is an ongoing challenge. This issue is further complicated by the fact that a higher proportion of recommendations by the US Preventive Services Task Force (USPSTF) for pediatric preventive services in comparison with adult services have insufficient evidence to recommend for or against the service. One important root cause for this problem is the relative lack of high quality screening and counseling studies in pediatric primary care settings. The paucity of studies limits the development of additional evidence-based guidelines to enhance best practices for pediatric and adolescent conditions. In this article, we describe the following: (1) evidence-based primary care preventive services as a strategy for addressing important pediatric morbidities, (2) the process of making evidence-based screening recommendations by the USPSTF, (3) the current library of USPSTF recommendations for children and adolescents, and (4) factors influencing the use of USPSTF recommendations and other evidence-based guidelines by clinicians. Strategies to accelerate the implementation of evidence-based services and areas of need for future research to fill key gaps in evidence-based recommendations and guidelines are highlighted.

The Intersection of Evidence and Values in Clinical Guidelines: Who Decides What Constitutes Acceptable Risk in the Care of Children?

“…The US Preventive Services Task Force's use of the insuffi cient evidence (I) rating in favor of a rating category based on expert opinion or weak evidence offers a good example of acknowledging uncertainty when it exists. 7 Not only can a recommendation based simply on expert opinion 8 have negative consequences for patients if followed, 9 but failing to be explicit about recommendations based on weak evidence can also contribute to the misperception that there is no reasonable clinical alternative to the guideline. This was illustrated in a recent case discussion on the management of a newborn whose mother was diagnosed with chorioamnionitis 10 and prompted us to publish a commentary criticizing the Centers for Disease Control and Prevention's guidelines for not explicitly acknowledging and incorporating this uncertainty into their recommendations.…”

Transforming Evidence Generation to Support Health and Health Care Decisions

“…In addition, mental health disorders and substance use starting in adolescence can continue for decades. The lack of data from intervention studies and the difficulty of measuring the current or future health of children and adolescents has resulted in many I statements from the Task Force, which can be frustrating for pediatric practitioners and families seeking concrete advice for common clinical issues (Melnyk, Grossman, Chou et al, 2012 This report summarizes evidence gaps for high-priority prevention issues in childhood and adolescence, for which many of the Task Force's most current assessment is an I statement (see Table 3). Filling these gaps in knowledge will allow the Task Force to revisit some of these recommendations, with the expectation that more definitive recommendations will follow.…”

Modelo de Enfermería para optimizar sistemas de salud

“…Estas metas se acentúan frente a una realidad donde las variaciones en la práctica clínica persisten y así también el daño de estas a los ciudadanos (1). Hace más de 30 años Wennberg y Gittelsohn (1973) describieron por primera vez la variación en los patrones de tratamiento en Nueva Inglaterra y otros lugares de los Estados Unidos (2).…”

“…En Canadá, el 95% de las fracturas de cadera y el 85% de las hospitalizaciones relacionadas con lesiones en adultos mayores se deben a caídas 1 . Se calcula que los costos directos anuales de atención de la salud son de 2.000 millones de dólares canadienses debido a caídas, y los adultos mayores representan casi la mitad de estos costos 2 .…”