Monday, April 18, 2016

A 1-page adult preventive health care schedule

For many years, the Centers for Disease Control and Prevention has published yearly single-page schedules of childhood and adult vaccinations recommended by its Advisory Committee on Immunization Practices. Even today, when this information can be easily referenced online or in a smartphone app, you will still see copies of these schedules taped to the walls of workstations in primary care physicians' offices. Until recently, an analogous schedule of adult preventive services recommended by the U.S. Preventive Services Task Force hasn't existed (though the Agency for Healthcare Research and Quality published a popular spiral-bound Guide to Clinical Preventive Services that included abridged versions of USPSTF recommendations for patients of all ages).

Family physician Paul Swenson, in collaboration with my American Family Physician editor colleague and former USPSTF member Mark Ebell, has filled this gap by creating a 1-page adult preventive health care schedule in AFP that contains all "A" and "B" grade recommendations relevant to adults as of April 5, 2016. This schedule will be updated periodically online and published in the journal annually, as are the CDC vaccination schedules. That's a good thing, since it is already slightly out of date - the USPSTF updated its recommendations on aspirin for primary prevention just last week. Clinicians or health professionals in training can read or listen to my latest Medscape commentary for the details on what's changed. For everyone else, here is the bottom line:

This time around, the Task Force narrowed the age range of patients for whom clinicians should consider preventive aspirin to 50-69 years and removed the previous distinction between men and women, recognizing newer evidence that both sexes benefit from reductions in heart attacks and strokes, as well as a decreased incidence of colorectal cancer. The USPSTF recommends that adults in their 50s start low-dose aspirin if they have a 10% or greater 10-year cardiovascular disease (CVD) risk, do not have bleeding risk factors, and are willing to take aspirin for at least 10 years. Adults in their 60s with similar CVD risk can also consider starting low-dose aspirin but are at higher risk of bleeding and so are less likely to benefit overall.

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