Clinical Preventive Services for Women Closing the Gaps (2011) / Chapter Skim
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The preventive health care services and screenings specified in the legislation will be fully covered without requiring a patient copayment. These include the services with Grade A and B recommendations made by the United States Preventive Services Task Force (USPSTF)
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In conducting its work, the committee will: conduct a series of meetings to examine existing prevention guidelines, obtain input from stakeholders, identify gaps that may exist in recommended preventive services for USPSTF Grade A and B pre ventive services guidelines for women and in Bright Futures and USPSTF Grade A and B guidelines for adolescents, and highlight specific services and screenings that could supplement currently recommended preventive services for women. Specifically, the committee will consider the following questions: • hat is the scope of preventive services for women not included in those W graded A and B by the USPSTF?
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BOX S-2 Definition of Preventive Health Services For the purposes of this study, the Committee on Preventive Services for Women defines preventive health services to be measures -- including medications, procedures, devices, tests, education and counseling -- shown to improve well being, and/or decrease the likelihood or delay the onset of a targeted disease or condition. COMMITTEE'S METHODOLOGY The committee's methodology to identify preventive services necessary for women's health and well-being and to identify specific services that could supplement the current list of recommended preventive services for women under the ACA follows.
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Furthermore, the committee compared USPSTF guidelines with those of numerous health care professional organizations to identify potential gaps. The committee recognized that USPSTF Grade C recommendations and I statements warranted further analysis because the USPSTF did not develop and has not used these grades as support to offer or deny coverage of a preventive service.
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to describe topics to be covered as preventive services under the ACA and addressed in an annual health care visit of sufficient length to cover age- and sex-appropriate topics in the health domain. The committee assumes that physicians will identify priorities from this section of the Bright Futures report on the basis of the unique circumstances of each patient.
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The committee also performed targeted literature searches. However, it should be noted that the committee did not have adequate time or resources to conduct its own meta-analyses or comprehensive systematic review of each preventive service.
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Are there existing federal, state, or international practices, professional guidelines, or federal reimbursement policies that support the use of the measure? RECOMMENDATIONS Subcommittees were formed, and each subcommittee reviewed the available evidence applicable to its identified potential preventive measure(s)
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• Ultimately, the decision to develop a recommendation for a preventive service to be considered was made after a thoughtful review and debate of each of the subcommittee reports and when the committee found the evidence to be compelling. TABLE S-1 Summary of the Committee's Recommendations on Preventive Services for Women Preventive USPSTF Service Grade Supporting Evidence Recommendations Recommendation 5.1 Screening for I The evidence provided to gestational support a recommendation The committee diabetes for screening for gestational recommends for diabetes is based on current consideration as a federal practice policy from preventive service for the U.S.
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Recommendation 5.3 Counseling I The evidence provided to for sexually support a recommendation The committee transmitted related to STI counseling recommends for infections is based on federal goals consideration as a (STIs) from the Centers for Disease preventive service for Control and Prevention and women: annual counseling Healthy People 2020, as on sexually transmitted well as recommendations infections for sexually from the American Medical active women.
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of America, the American Medical Association, and the American College of Obstetricians and Gynecologists. Recommendation 5.5 Contraceptive Not The evidence provided to methods and Addressed support a recommendation The committee counseling related to unintended recommends for pregnancy is based on consideration as a systematic evidence preventive service for reviews and other peer- women: the full range reviewed studies, which of Food and Drug indicate that contraception Administration-approved and contraceptive contraceptive methods, counseling are effective sterilization procedures, at reducing unintended and patient education and pregnancies.
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committee recognizes that interpretation of this varies.) Recommendation 5.7 Screening and I The evidence provided to counseling for support a recommendation The committee interpersonal related to increasing recommends for and domestic detection of and counseling consideration as a violence for domestic violence and preventive service for abuse is based on peer- women: screening review studies and federal and counseling for and international policies, interpersonal and in addition to clinical domestic violence.
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UPDATING GUIDELINES Developing and maintaining a comprehensive list of covered preventive services for women is not currently under the specific purview of any HHS entity. Thus, the committee believes that it will be necessary to develop structures, accountability, and processes to ensure that preventive services meeting evidence-based standards are considered in the context of the general approach taken to identify and update preventive services for women.
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• Recommendation 6.3: The committee recommends that the Secretary of HHS identify existing bodies or appoint new ones as needed to review the evidence and develop clinical practice guidelines to be re viewed by a preventive services coverage commission. Bringing clinical preventive services into rational alignment with the coverage for other health care services under the ACA will be a major task.
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Figure S-1 illustrates the committee's suggested structure. In view of the critical importance of community-based preventive services in achieving clinical aims, the committee encourages the Secretary to consider widening the scope of authority to include public health efforts to more comprehensively address prevention.
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