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Recommendations

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the USPSTF Web site, details the most updated version of the process for evaluating the quality and strength of the evidence for a service, determining the net health benefit (benefit minus harms) associated with the service, and judging the level of certainty that providing these services will be beneficial in primary care. We continue to explore the appropriate use of mathematical modeling to help fill research gaps regarding the ages at which to start and stop providing a service, and at what time intervals. In addition, we are committed to improving the communication of our recommendations to a broader audience, including patients and policymakers. The letter grade linked to each recommendation reflects both the magnitude of net benefit and the strength and certainty of the evidence supporting the provision of a specific preventive service. These grades translate to practice guidance for clinicians: ■■ ■■ ■■ ■■ Discuss services with “A” and “B” recommendation grades with eligible patients and offer them as a priority. Discourage the use of services with “D” recommendation grades unless there are unusual additional considerations. Give lower priority to services with “C” recommendation grades; they need not be provided unless there are individual considerations in favor of providing the service. Help patients understand the uncertainty surrounding services with “I” (insufficient evidence) statements, which reflect the conclusion that the evidence is insufficient to determine net benefit. The Clinical Considerations section of each full recommendation statement offers additional guidance. The USPSTF recognizes that clinical decisions about patients involve more complex considerations than the evidence alone; clinicians should always understand the evidence but individualize decisionmaking to the specific patient and situation. The Clinical Considerations section of each USPSTF recommendation statement helps clinicians by offering practical information so they can tailor these recommendations to individual patients. We strongly encourage clinicians to visit the USPSTF Web site and read the complete recommendation statements for services relevant to their patients. Additional information is available to facilitate the delivery of the highest quality preventive care. For each topic, educational materials have been developed for use with patients and the public. Special materials developed for clinicians are also available on some complex topics, such as prostate and lung cancer screening, along with links to informative Web sites. In addition, the USPSTF Electronic Preventive Services vi
Selector (ePSS), available via PDA, smart phone, or on the Web at epss.ahrq.gov, allows users to search USPSTF recommendations by patient age and other clinical characteristics. We hope you find the Guide to Clinical Preventive Services 2014 to be a useful tool as you care for patients. Based on the best medical evidence available, we are confident that by implementing these recommended services, you will help your patients live longer and healthier lives. Michael L. LeFevre, M.D., M.S.P.H., Chair Albert L. Siu, M.D., M.S.P.H., Co-Vice Chair Kirsten Bibbins-Domingo, Ph.D., M.D., M.A.S., Co-Vice Chair U.S. Preventive Services Task Force vii
Page 1 and 2: The Guide to Clinical Preventive Se
Page 3: The Guide to Clinical Preventive Se
Page 7: Preface The U.S. Preventive Service
Page 12 and 13: Hemochromatosis, Screening.........
Page 15: Preventive Services Recommended by
Page 18 and 19: Section 1: Preventive Services Reco
Page 20 and 21: 4 13 Asymptomatic adults with susta
Page 23 and 24: Abdominal Aortic Aneurysm Title Scr
Page 25 and 26: Aspirin for the Prevention of Cardi
Page 27 and 28: Bacterial Vaginosis in Pregnancy Ti
Page 29 and 30: Bladder Cancer Title Population Rec
Page 31 and 32: Breast Cancer (Preventive Medicatio
Page 33 and 34: Breastfeeding Title Primary Care In
Page 35 and 36: Cervical Cancer Title Screening for
Page 37 and 38: Chronic Kidney Disease Title Popula
Page 39 and 40: Cognitive Impairment Title Populati
Page 41 and 42: Coronary Heart Disease (Risk Assess
Page 43 and 44: Depression in Adults Title Populati
Page 45 and 46: Falls in Older Adults Title Populat
Page 47 and 48: Genital Herpes Time Screening for G
Page 49 and 50: Glaucoma Title Population Recommend
Page 51 and 52: Healthful Diet and Physical Activit
Page 53 and 54: Hemochromatosis Title Population Re
Page 55 and 56: Hepatitis C Virus Infection Title S
Page 57 and 58: HIV Infection Title Population Reco
Page 59 and 60:
Impaired Visual Acuity in Older Adu
Page 61 and 62:
Lipid Disorders in Adults Title Scr
Page 63 and 64:
Menopausal Hormone Therapy Title Me
Page 65 and 66:
Obesity in Adults Title Population
Page 67 and 68:
Osteoporosis Title Screening for Os
Page 69 and 70:
Peripheral Artery Disease Title Pop
Page 71 and 72:
Sexually Transmitted Infections Tit
Page 73 and 74:
Skin Cancer (Screening) Title Scree
Page 75 and 76:
Syphilis (Pregnant Women) Title Pop
Page 77 and 78:
Tobacco Use in Adults Title Counsel
Page 79:
Vitamin Supplementation to Prevent
Page 83 and 84:
Blood Lead Levels in Children and P
Page 85 and 86:
Congenital Hypothyroidism Title Scr
Page 87 and 88:
Gonococcal Ophthalmia Neonatorum Ti
Page 89 and 90:
High Blood Pressure (Children) Titl
Page 91 and 92:
Illicit and Prescription Drug Use i
Page 93 and 94:
Iron Deficiency Anemia (Supplementa
Page 95 and 96:
Major Depressive Disorder in Childr
Page 97 and 98:
Phenylketonuria (PKU) Title Populat
Page 99 and 100:
Speech and Language Delay Title Pop
Page 101:
Visual Impairment in Children Ages
Page 105:
Immunizations for Adults and Childr
Page 109 and 110:
Topics in Progress Each USPSTF reco
Page 111:
Appendixes and Index
Page 114 and 115:
Grade Definitions What the Grades M
Page 116 and 117:
Grade Definitions Prior to May 2007
Page 118 and 119:
David Grossman, M.D., M.P.H. Center
Page 120 and 121:
Appendix C Acknowledgements AHRQ St
Page 122 and 123:
Liaisons to the USPSTF Primary care
Page 124 and 125:
The Task Force does not explicitly
Page 126 and 127:
■■ ■■ Access the Electronic
Page 128 and 129:
Appendix E More Resources AHRQ’s
Page 130 and 131:
Healthy People 2020 Healthy People
Page 133 and 134:
Index 2-hour postload plasma (see D
Page 135 and 136:
Coronary Heart Disease (Risk Assess
Page 137 and 138:
*Illicit and Prescription Drug Use
Page 139:
Syphilis Infection (Pregnant Women)
Page 143 and 144:
The U.S. Preventive Services Task F
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