Doctors should spend more time talking to their patients about how to take better care of themselves and less time conducting routine tests without any proven value, according to a new report released by a group of prominent preventive health specialists.
The report, released by the United States Preventive Task Force, an independent panel of preventive health specialists first convened in 1984, reflects new evidence about important health benefits of selected preventive services.
In addition, the report, a complete update of guidelines first issued by the taskforce in 1989, reflects a more critical look at what sponsors say does and does not work with regard to preventive health practices.
The task force issued new recommendations for and against 200 different interventions for more than 70 common diseases and conditions ranging from cancer to chickenpox.
Some of the selected recommendations the group has endorsed include:
* Annual fecal occult blood testing to screen for colorectal cancer.
* Routine cholesterol tests for men aged 3 5 to 65 and women aged 45 to 65, and others at increased risk for heart disease.
* Routine vaccinating for all newborns, children, adolescents and young adults against hepatitis B.
The task force came out against the following:
* Routine screening for prostate cancer with prostate-specific antigen (PSA) or digital rectal examination.
* Urine tests for early detection of bladder cancer or asymptomatic urinary tract infection.
Authors of the study said it should help medical providers throughout the health care system determine what route to best take when providing preventive care.
The task force 'follows the philosophy that when you're offering [Preventive treatment] to somebody who is healthy, the provider has to weigh the costs and [potential] harms to the patient,' said Dr. Harold Sox, a professor of medicine at Dartmouth Medical School and chair of the task force.
'Doctors should spend more time talking to their patients' about how to take better care of themselves through behavioral changes 'and less time doing routine tests that don't have any proven value, ' said Dr. Sox, referring to urine tests to detect the presence of cancer.
Indeed, one of the principal findings of the latest report is that counseling patients about personal health practices--smoking, diet, physical activity, drinking, injury prevention and sexual practices--remains one of the most 'underused, but important' parts of the health visit.
'Most leverage on health status comes from people working on behavioral changes,' said Dr. Donald Berwick, vice chair of the task force and president of the Institute for Healthcare Improvement, Boston.
The American Medical Association, for its part, supports the development of these criteria of preventive services but is not in agreement with all of the panel's recommendations, according to Nancie Steinberg, a spokeswoman for the AMA. She would not elaborate.
Members of the managed care community, meanwhile, applauded the recommendations.
In a letter to the task force, Carmell Bocchino, director of medical affairs for the Group Health Association of America/American Managed Care and Review Association, which represents 800 managed care organizations, said the guide offers a 'practical approach to assessing the validity of preventive services and the potential impact of clinical preventive services on improving health status.'
Said Dr. Berwick: 'Managed care organizations have an opportunity to engineer the processes and services able to carry out the recommendations in the report.'
