Preventive Services Task Force Research Articles

Pharmacist-Led Deprescribing of Aspirin in Older People in an Outpatient Setting.

Background In 2019, the American College of Cardiology and American Heart Association updated their joint guidelines stating low-dose aspirin should not be used on a routine basis for primary prevention of atherosclerotic cardiovascular disease (ASCVD) among people older than 70 years of age because of increased bleeding risk.1 In addition to these updated guidelines, a statement released by the US Preventive Services Task Force in April 2022 recommends against the initiation of low-dose aspirin for primary prevention of cardiovascular disease in people 60 years of age or older.² Despite these updated recommendations, aspirin continues to be a common medication older patients take, providing an opportunity for a clinical pharmacist deprescribing intervention. Objective To identify the role of a pharmacist-led aspirin deprescribing intervention within a safety-net health system in the outpatient setting. Methods This project included patients 70 years of age and older who had aspirin listed as an active medication without documented ASCVD. This project assessed aspirin deprescribing rates, time spent on pharmacist outreach, and reasons for patient and/or provider refusal to discontinue aspirin. Results One hundred thirty-one eligible patients were contacted. Of those, 78 (60%) patients discontinued aspirin after speaking with the pharmacist, and 8 patients discontinued aspirin after a clinical pharmacist recommendation to the patient's primary care provider (PCP). The median time spent on outreach was approximately eight minutes. Of the 6 patients who consented to the project but declined to discontinue aspirin therapy based on pharmacist intervention, 5 preferred to discuss the issue with their PCP, while 1 patient was told by an outside provider to take aspirin. Conclusion Results indicate the successful impact a clinical pharmacist may have in deprescribing aspirin in a high-risk population. These data may also suggest that an active and intentional approach to deprescribing is likely to be more effective than a written recommendation to providers.

Tamoxifen for breast cancer prevention among survivors of pediatric lymphoma previously treated with chest radiation: Clinical benefits, harms and tradeoffs.

10025 Background: Survivors of pediatric lymphoma previously treated with chest radiation are at high risk for subsequent breast cancer. Although early initiation of breast cancer screening is recommended, the clinical benefits and harms of adding tamoxifen to reduce breast cancer deaths among these women are unknown. Methods: We adapted a Cancer Intervention and Surveillance Modeling Network (CISNET) breast model using data from the Childhood Cancer Survivor Study (CCSS) to reflect the elevated risks for breast cancer and competing mortality for 5-year survivors previously treated with chest radiation (RT). Breast cancer risk was based on age, chest RT field, timing of RT relative to menarche, menopause status, anthracycline exposure, and family history. Premature menopause risk varied by cumulative ovarian RT and alkylator dose. Based on the US Preventive Services Task Force 2019 Evidence Summary, we assumed tamoxifen (20mg daily for 5 years) reduced estrogen receptor positive (ER+) breast cancer risk by 42% (RR = 0.58 [0.42-0.81]) for 20 years and increased risks for venous thromboembolism, deep vein thrombosis, coronary heart disease, stroke and endometrial cancer during treatment. Strategies included no screening or tamoxifen, annual screening with mammography and MRI starting at age 25, annual screening with mammography and MRI starting at age 25 with the addition of tamoxifen at ages 25, 30 or 35. Model outcomes included cumulative breast cancer risk, number of childbearing years before age 45 (defined as years menstruating without tamoxifen use or a breast cancer diagnosis or having survived breast cancer for at least 3 years), and number of tamoxifen-related side-effects. Results: Among a cohort of 20-year-old 5-year lymphoma survivors previously treated with mediastinal RT without primary ovarian failure, an estimated 20% were projected to develop breast cancer and 2.6% would die from the disease before age 50 in the absence of screening or tamoxifen use. Survivors would have on average 22 childbearing years before age 45. Early initiation of breast cancer screening at age 25 would reduce breast cancer deaths before age 50 by 56.3%. Depending on age at initiation, tamoxifen would further reduce breast cancer deaths by 8.0 to 9.6 percentage points for an overall 64.3% to 65.9% reduction and reduce the average number of childbearing years by 17% to 21%. For each breast cancer death averted, a reduction of 1950 to 3740 childbearing life years and 11 to 20 side-effects would occur and varied by the tamoxifen start age compared to mammography and MRI screening. Conclusions: Tamoxifen use for primary breast cancer prevention among pediatric lymphoma survivors may further reduce breast cancer deaths but decisions might depend on survivor preferences for side effects vs. avoiding breast cancer and consideration of timing for childbearing.

Perspectives on Clinical Adoption Barriers to Blood-Based Multi-Cancer Early Detection Tests across Stakeholders.

Current United States Preventive Services Task Force (USPSTF) recommendations include routine screening for breast, cervical, colorectal, and lung cancer; however, two out of every three cancer cases occur in other indications, leading to diagnoses in advanced stages of the disease and a higher likelihood of mortality. Blood-based multi-cancer early detection (MCED) tests can impact cancer screening and early detection by monitoring for multiple different cancer types at once, including indications where screening is not performed routinely today. We conducted a survey amongst healthcare providers (HCPs), payers, and patients within the U.S. health system to understand the current utilization of cancer screening tests and the anticipated barriers to widespread adoption of blood-based MCED tests. The results indicated that the community favors the adoption of blood-based MCED tests and that there is broad agreement on the value proposition. Despite this recognition, the survey highlighted that there is limited use today due to the perceived lack of clinical accuracy and utility data, high out-of-pocket patient costs, and lack of payer coverage. To overcome the hurdles for future widespread adoption of blood-based MCED tests, increased investment in data generation, education, and implementation of logistical support for HCPs will be critical.

Perspectives on clinical adoption barriers to blood-based multi-cancer early detection tests across stakeholders.

e13574 Background: Current United States Preventive Services Task Force (USPSTF) recommendations include routine screening for breast, cervical, colorectal, and lung cancer; however, two out of every three cancer cases occur in other indications leading to diagnosis in advanced stages of the disease and higher likelihood of mortality. Current recommended cancer screening and early detection tests also face several hurdles hindering equitable access in a real-world setting. Blood-based MCED tests can impact cancer screening and early detection by monitoring for multiple different cancer types at once via a blood draw that can detect cancers in multiple indications, including indications where screening is not performed routinely today. Given their nascency, the role of blood-based MCED tests in clinical practice is currently undefined. To help facilitate the appropriate integration of MCED tests into patient care, it is important to understand the perspectives of stakeholders on the anticipated challenges to implementation. Methods: We conducted three separate double-blinded surveys in July 2023 of representative cohorts of U.S. Healthcare providers (HCPs) (n=238) that are or act as primary care providers (general practitioners and obstetrics and gynecologists (OB-GYNs)), payers (n=40), and patients (n=116), to evaluate the current cancer screening and early detection landscape and gather perspectives on barriers to implementation of new cancer screening technologies, including blood-based MCED tests. Results: Of the surveyed HCPs and payers, >90% and 100% respectively reported to be aware of MCED tests. However, <10% of HCPs reported having ordered an MCED test and 80% of payers had not yet evaluated an MCED test for coverage under their plan at the time of the survey. The survey results indicated that there is broad agreement on the value proposition that blood-based MCED tests would improve patient outcomes with earlier intervention. Despite this recognition, the survey highlighted that there is limited use today due to the perceived lack of clinical accuracy and utility data, high out-of-pocket patient costs, and lack of payer coverage. Conclusions: To overcome the hurdles for future widespread adoption of blood-based MCED tests, increased investment in data generation, education, and implementation of logistical support for HCPs will be critical. Initiatives include collaborations between stakeholders to generate near-term clinical utility data, equipping HCPs with the ability to educate patients on test accuracy, and seamlessly integrating the testing process into the patient visit workflow. The findings of this study can help build understanding of the anticipated barriers and inform strategies to alleviate them and build a foundation for clinical adoption of blood-based MCED tests.

E-cigarette use and United States Preventive Services Task Force (USPSTF) lung cancer screening (LCS) eligibility.

10531 Background: Electronic cigarettes (E-cigarettes) have become frequently used as a smoking cessation tool. Emerging research has shown that e-cigarettes have similar carcinogenic effects as combustible cigarettes. While current lung cancer screening (LCS) guidelines primarily rely on individuals’ smoking history, it's becoming increasingly important to understand the prevalence of e-cigarette use among individuals, especially in the context of their LCS eligibility. Methods: Individuals aged 40-80 years were extracted from the 2022 Behavioral Risk Factor Surveillance System. Eligibility was defined using the 2021 USPSTF LCS criteria, i.e., aged 50-80 years who ever smoked, with at least a 20-pack-year smoking history, currently smoke or quit within the past 15 years. We compared the prevalence of current and ever e-cigarette use among LCS-eligible and non-eligible populations, overall and by smoking (combustible cigarettes) status using chi-square tests. All analyses were weighted. The significance level was set at a 2-sided p-value of <0.05. Results: Among the 208,317 individuals included, 9.9% were eligible for LCS. Overall, 3.8% and 22.1% reported current and ever cigarette use, respectively. Fewer LCS-ineligible individuals reported currently using e-cigarettes than their LCS-eligible counterparts (Table). Among former combustible cigarette users, LCS-ineligible individuals were less likely to be current e-cigarette user than LCS-eligible individuals. However, among current combustible cigarette users, LCS-ineligible individuals were more likely to be current e-cigarettes users than LCS-eligible individuals. When examining the prevalence of ever e-cigarette use, similar findings were observed. Conclusions: Our study reveals a significant prevalence of e-cigarette usage among older adults (aged 40-80), with 1 in 5 individuals reporting ever having used e-cigarettes. Moreover, current cigarette users who were ineligible for LCS were more likely to use e-cigarette than their LCS-eligible counterparts. Future epidemiological studies are warranted to assess the risk of e-cigarette use (including intensity, duration and interactions with combustible cigarettes) and lung cancer risks. E-cigarette use may need to be considered in formulating future LCS guidelines. [Table: see text]

Enhancing early detection of lung cancer: A strategic initiative to boost screening rates among patients.

e22512 Background: Lung cancer is the top cause of cancer death in the U.S. Despite LDCT screenings reducing mortality, uptake is low in Alabama and nationally (6% vs. 4.5%). The U.S. Preventive Services Task Force recommends annual LDCT for certain high-risk adults, but factors like awareness, access, and policy affect screening rates. Alabama's situation is worsened by rural disparities and socioeconomic issues. Infirmary Health is the largest private, not for profit health care system in the state of Alabama. This study focuses on evaluating LDCT screening in a selected clinic of our health care system, pinpointing obstacles to adherence, and seeking ways to boost screenings to lower lung cancer mortality through early detection. Methods: As part of the Summer 2023 ASCO Quality Training Program we adopted a QI approach to increase LDCT lung cancer screening. It began by assessing baseline screening rates and staff knowledge, then created problem and aim statements. The team conducted root cause analysis, used a Pareto chart for issue prioritization, and employed a Priority Pay-off Matrix to focus on impactful, feasible issues. The Plan-Do-Study-Act (PDSA) cycle was then used to develop, test, and implement interventions, ensuring strategic alignment and effective monitoring of outcomes to enhance screening rates. Results: From January to July 2023, the Infirmary Health -Hillcrest clinic had a low 10.53% LDCT screening rate (system wide 6%, this clinic was selected due to it's highest screening rate), leading to late-stage lung cancer diagnoses and higher mortality. To address this, a goal was set to triple the screening rate to 30% by December 2023. Key barriers identified were staff and patient knowledge about lung cancer screening and a cumbersome LDCT ordering process. A PDSA cycle initiated between September and December 2023, firstly focused on Patient/Clinic Education, increasing screening rates by simplifying the process—removing doctor signature requirements and enhancing staff knowledge through meetings and informative flyers. The subsequent phase introduced a Nurse Navigator, who further increased screenings through prescreening, staff reminders, and on-site visits. By December of 2023 the LDCT screening rate was increased from baseline 10.53% to 33.3%. Conclusions: Through identifying and addressing key issues like education, faulty process and nurse navigation we successfully elevated LDCT screening rates. This study highlights the benefit of participating in a structured quality training program. [Table: see text]

Lung cancer screening among women Veterans within the Veterans’ Health Administration.

10537 Background: Despite advancements in survival rates, lung cancer remains the leading cause of cancer-related deaths among women in the United States (US). In response to this challenge, the United States Preventive Services Task Force (USPSTF) issued updated guidelines in 2021 to broaden the pool of eligible candidates for lung cancer screening (LCS). Pioneering initiatives, such as the Lung Cancer Screening Demonstration Project (LCSDP) launched by the Veterans Affairs (VA) in 2012, have played a pivotal role in evaluating the feasibility of implementing Low-Dose Computed Tomography (LDCT) at eight Veterans Affairs Medical Centers (VAMC). Subsequently, the program has undergone substantial expansion. Projections within the veteran community indicate a notable increase in the proportion of women veterans, from 11% in 2023 to an anticipated 18% in 2048. However, scant information is currently available regarding the lung cancer screening patterns within this expanding demographic. Methods: Women veterans ages 55 -80, current or former smokers from 2015- 2021 were identified through the VA corporate data warehouse (CDW). ICD 9/10 codes were used to identify women veterans with a lung cancer diagnosis. Diagnoses were verified via chart review. Data were analyzed using R Studio software. Results: Of the women veterans identified (n=44,342), 10,623 received LCS (24%) and 942 (2%) had a primary diagnosis of lung cancer. In the cohort of 942 women diagnosed, 286 (30%) had received lung cancer. Women veterans diagnosed with lung cancer tended to be aged >65 (55%), white (72%), single (72%), unemployed (71%), and urban dwelling (70%) within the southeastern US (35%). Compared to women veterans who did not receive LCS, those who did had higher rates of localized disease (47% vs 34%) and lower rates of metastatic disease (12% vs 19%). Factors associated with higher rates of LCS included mammography (60% vs 49%), a family history of lung cancer (4% vs 2%) and living in the southeastern US (46% vs 35%). It is to be noted that 23% of the women veterans who were screened lived in rural areas and 18.53% identified as black. 98.9% of the women had reported current or former tobacco use but the data on pack year history was missing in 87.6% of charts. Conclusions: While further progress can be made, it is notable that 24% of women veterans received LCS, surpassing national averages. This discrepancy underscores the potential to advance efforts in establishing a comprehensive and structured lung cancer screening initiative, thereby facilitating the equitable inclusion of historically marginalized groups, particularly minorities and rural populations. The findings emphasize the imperative to overcome existing impediments to nationwide enrollment and retention in LCS. Lastly, the study underscores the necessity for increased resource allocation towards tobacco cessation initiatives as an integral component of the broader expansion strategy.

LDCT lung cancer screening implementation in a Veterans Affairs hospital: A quality initiative.

e23238 Background: Lung cancer is the number one cause of cancer related deaths worldwide. United States Preventive Services Task Force (USPSTF) recommends annual Lung Cancer Screening (LCS) with Low Dose Computerized Tomography (LDCT) for adults who are current smokers aged 50 to 80 years with at least 20 pack year smoking history or have quit smoking within the past 15 years. Although LCS is a national initiative for Veteran Affairs (VA) Hospitals, there are several barriers in practice. Methods: The LCS program was established with a dedicated coordinator to provide better access to high-quality in-house screening, while reducing the dependance on expensive community care services and referrals. Smoking history in Tobacco Pack Years (TPY) is updated during a Primary Care Physician (PCP) visit, which triggers a clinical reminder in the electronic medical record for LCS. The LCS coordinator would then receive a consult. After shared decision-making with the patient, physician and coordinator, the patients are scheduled for LDCT. If the results are Lung-RADS 1 (negative), 2 or 3 (benign appearing nodules) the patients are notified of the findings and provided with subsequent follow ups. All Lung RADS 4 (suspicious findings) are discussed in the lung tumor board, which includes radiologist, oncologist, pulmonologist, pathologist, cardio-thoracic surgeon, and fellows in training. The committee determines the follow-up scan interval and/or additional investigations. Results: The performance of our LCS Program from June 2022 to January 2024 was reviewed. 5941 patients were assessed for TPY, of those 1127 patients were eligible for LCS scans and 1032 (93.3%) were enrolled into the LCS Program. 951 LDCT scans have been conducted thus far, this includes 598 annual initial screenings, the remaining are follow ups. 57 patients (6.81%) had Lung-RADS 3 findings and are undergoing nodule tracking. 16 patients (1.91%) required diagnostic work-up which includes a PET scan or biopsy. 14 patients (1.67%) have been diagnosed with cancer. Conclusions: Our LDCT Program showed a high acceptance rate of 93.3%, much of which can be attributed to the multiple layers of screening and shared decision-making processes. Patients received three phone calls and a letter as a reminder of their LDCT appointments. Our radiology department has four dedicated slots for LDCT screening each day which allows for further compliance. TPY documentation was identified as a limiting factor in this process. The LCS coordinator verified the TPY history with the patients which helped overcome this shortcoming. Overall a multidisciplinary team approach contributed to the success of our program.

Artificial intelligence–aided lung cancer screening in routine clinical practice: A pilot of LungFlag at Geisinger.

e13604 Background: Use of low-dose computed tomography (LDCT) in lung cancer screening is recommended for early detection and can reduce mortality. LungFlag (Medial-EarlySign) is a machine-learning risk prediction model that identifies individuals at high risk of non-small cell lung cancer so their care team may recommend LDCT screening. The LungFlag model was developed using data from Kaiser Permanente Southern California and is being implemented in a pilot at Geisinger. Here we provide an overview of the clinical workflow for the LungFlag pilot. Methods: Geisinger has implemented LungFlag into routine clinical practice via integration with the electronic medical record system. This pilot is examining the performance and clinical impact of LungFlag in the first year. LungFlag runs every month to provide risk evaluation for individuals 50 to 80 years old who are eligible for annual lung cancer screening according to US Preventive Services Task Force recommendations. Eligible individuals have a 20 pack-year smoking history, no lung cancer history, and currently smoke or quit within the past 15 years. Patients with cancer history in the past 5 years and those screened or scheduled for screening in the past year are excluded. LungFlag identifies the top 30 individuals with the highest LungFlag scores per month (high-risk patients) and refers them for targeted outreach from a lung cancer screening program nurse navigator. A positive LungFlag result prompts nurse navigator chart review, patient outreach, and coordination with the primary care provider. Flagged individuals are contacted (up to 3 phone calls) and encouraged to receive lung cancer screening. Individuals not flagged by the model (non–high-risk patients) receive usual care consisting of reminders for lung cancer screening during primary care visits without additional targeted outreach and high-risk prioritization. Results: The LungFlag pilot was initiated in August 2023 and will continue until August 2024. As of January 2024, risk profiles of >12,000 patients were analyzed and 180 high-risk patients were identified. Conclusions: This pilot is the first evaluation of the implementation process for the LungFlag model in routine clinical practice. After the pilot, a retrospective observational study is planned to further assess the impact of LungFlag and the associated clinical workflow in identifying high-risk individuals and increasing compliance with LDCT screening among high-risk individuals.

Mortality outcomes in early versus late onset colorectal cancer: A US National Inpatient Sample (NIS) analysis (2020).

e15651 Background: Colorectal Cancer (CRC) is the third most common cancer diagnosed in the United States and contributes to significant cancer-related morbidity and mortality. An upward trend in the incidence is noticed in the population below 50 years of age. For similar reasons, U.S. Preventive Services Task Force recommended screening at the age of 45 in 2021.For the sake of this study, we categorized early onset (EO) for age 45 and below, and late onset (LO) for above 45 years per new screening criteria. We compared socioeconomic characteristics, mortality, length of stay and hospital cost between EO and LO CRC. Methods: It is a retrospective cohort study of adult patients hospitalized in 2020 with Colorectal cancer in acute care hospitals across the USA. Patients were selected from the Nationwide Inpatient Sample (NIS) database. IRB approval was not obtained as de-identified data was utilized. Our study population included all patients with a discharge diagnosis of colorectal cancer as their primary diagnosis using the International Classification of the Diseases (ICD-10). The primary outcome was in-hospital mortality, secondary outcomes were length of hospital stay and total hospitalization charges. Analysis was performed using STATA version 18.0. Univariable and Multivariable logistic regression analysis were used to adjust for potential confounders. Results: There were 32 million discharges included in the NIS database in 2020, our study included 153809 with colorectal cancer which includes 12043 in EO and 141750 in LO CRC. Both population groups are mostly similar in terms of baseline characteristics, however EO group were more likely to have Hispanic population (18.7% vs 9.5%), history of inflammatory bowel disease (2.9% vs 1.2%), family history of CRC (6.4% vs 3.8%) and smoker (15.8% vs 12.8%). Multivariable analysis revealed that Age, Sex, Charlson Comorbidity Index, Family history, Smoking, and Median household income for patients were predictors of mortality. There was no statistically significant difference found in the adjusted mortality between the two groups (odds ratio 1.08, 95% CI 0.84-1.39). Lower length of stay was noticed in the EO group (odds ratio 0.48, 95% CI 0.07-0.89). Total deaths are lower in EO than LO group (0.04% vs 0.06%). Conclusions: There is no difference in mortality in early and late onset CRC in our study. However, EO CRC is associated with shorter length of stay in hospital. EO CRC disproportionately affects non-White patients, particularly Hispanic patients. [Table: see text]

Prostate cancer screening in Switzerland: a literature review and consensus statement from the Swiss Society of Urology.

Over a decade ago, the United States Preventive Services Taskforce (USPSTF) recommended against prostate-specific antigen (PSA)-based screening for prostate cancer in all men, which considerably influenced prostate cancer screening policies worldwide after that. Consequently, the world has seen increasing numbers of advanced stages and prostate cancer deaths, which later led the USPSTF to withdraw its initial statement. Meanwhile, the European Union has elaborated a directive to address the problem of implementing prostate cancer screening in "Europe's Beating Cancer Plan". In Switzerland, concerned urologists formed an open Swiss Prostate Cancer Screening Group to improve the early detection of prostate cancer. On the 20thof September 2023, during the annual general assembly of the Swiss Society of Urology (SGU/SSU) in Lausanne, members positively voted for a stepwise approach to evaluate the feasibility of implementing organised prostate cancer screening programs in Switzerland. The following article will summarise the events and scientific advances in the last decade during which evidence and promising additional modalities to complement PSA-based prostate cancer screening have emerged. It also aims to provide an overview of contemporary strategies and their potential harms and benefits.

Screening for Hypertensive Disorders of Pregnancy: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

(JAMA. 2023;330:11:1083–1091) The incidence of hypertensive disorders, including pre-eclampsia, during pregnancy has been increasing since the early 1990s, putting more pregnant women and neonates at risk of death or illness. The Black population is affected disproportionately, with the risk of dying of pre-eclampsia 5 times higher for Blacks than for Whites. In 2017, the US Preventive Services Task Force recommended screening pregnant women for pre-eclampsia by taking blood pressure (BP) readings throughout pregnancy at office visits. This systematic review examined different screening protocols to evaluate if some were more effective than others.

A Thorough Literature Review of the Potential Benefits and Drawbacks of Long-Term Aspirin Use for the Primary Prevention of Cardiovascular Disease.

This article examines the role of aspirin in the primary prevention of cardiovascular disease. It highlights findings from major studies such as ASPREE (ASPirin in Reducing Events in the Elderly), ARRIVE (Aspirin to Reduce Risk of Initial Vascular Events), and ASPREE-XT (ASPirin in Reducing Events in the Elderly - eXTension) , among others. The review focuses on aspirin's role in primary prevention for specific populations including older adults, diabetics, hypertension patients, rheumatoid arthritis patients, kidney transplant recipients, and those with specific lipoprotein(a) genotypes, among other groups. We review these studies, noting aspirin's role in reducing events such as myocardial infarctions and its potential for increasing bleeding risks. The review also considers the implications for patients with kidney disease, referencing the Chronic Renal Insufficiency Cohort (CRIC) study and the International Polycap Study-3 (TIPS-3) trial. Additionally, it addresses the shifting paradigms in guidelines from the US Preventive Services Task Force and other entities, underscoring the importance of individualized aspirin use by balancing benefits against bleeding risks. The article further explores the concept of platelet reactivity, discusses strategies for improving adherence to aspirin therapy, and identifies existing research gaps, such as the phenomenon of aspirin resistance. It concludes by suggesting potential areas for future investigation to enhance understanding and application of aspirin in cardiovascular disease prevention.

Folic Acid Supplementation to Prevent Neural Tube Defects Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

(JAMA. 2023;330(5):460–466) Neural tube defects are among the most commonly recorded birth defects for babies in the United States, and they are typically caused by low folate concentrations during conception and early gestation. These malformations can cause disabilities and even death in fetuses and children. In 2017, the United States Preventative Services Task Force (USPSTF) determined that women who increase their intake of folic acid before becoming pregnant can significantly help reduce the likelihood of their babies developing neural tube defects. The USPSTF also asserted their 2009 recommendation that patients should take 0.4 to 0.8 mg (400 to 800 μg) of folic acid daily if they were planning or capable of pregnancy, and that there was no consistent strong evidence of harmful adverse effects. This evidence report was conducted to analyze studies post-2017 for the USPSTF’s current recommendation on folic acid supplementation.

The Development of an Opioid Misuse Training Program for Physical Therapists: A Learning Community Approach.

Musculoskeletal pain and opioid misuse frequently co-occur. The US Preventive Services Task Force calls for all health care providers to be trained to screen for misuse and/or opioid use disorder. The purpose of this study was to develop and implement an opioid misuse training program that could be used by physical therapists. Thirteen practicing physical therapists were invited to participate in a curriculum development project. Using the Curriculum Framework, a collaborative learning approach was used to develop an opioid misuse training program and training manual for physical therapists. Four training sessions were provided virtually every 2 weeks. Topics included an introduction to the opioid crisis, screening, assessing, and communicating with patients and with the health care team about opioid misuse. Each didactic session was followed by a participant feedback session where participants provided recommendations on improving the training content and their impressions on the barriers and facilitators to incorporating the training into practice. A companion training manual was created and sent to participants for comment. Participants were asked over email to describe whether and how they incorporated training materials into clinical practice during the training curriculum. All participants attended sessions 1-3. Twelve (92.3%) attended the fourth session. Based on the participants' feedback, training sessions were edited, and a companion training manual was finalized and distributed to each participant. After the fourth session, 9 participants (69.2%) reported using what they learned in the training. During the participant feedback sessions, participants regarded the training as important. Some participants expressed barriers to discussing opioids with patients and concerns about whether the training was within physical therapists' scope of practice. An iteratively developed training program for physical therapists to address opioid misuse was acceptable, feasible, and provided immediate practice change by most participants.

Comparison of the characteristics of the population eligible for lung cancer screening under 2013 and population newly eligible under 2021 US Preventive Services Task Force recommendations.

In 2021, the United States Preventive Services Task Force (USPSTF) revised their 2013 recommendations for lung cancer screening eligibility by lowering the pack-year history from 30+ to 20+ pack-years and the recommended age from 55 to 50years. Simulation studies suggest that Black persons and females will benefit most from these changes, but it is unclear how the revised USPSTF recommendations will impact geographic, health-related, and other sociodemographic characteristics of those eligible. This cross-sectional study employed data from the 2017-2020 Behavioral Risk Factor Surveillance System surveys from 23 states to compare age, gender, race, marital, sexual orientation, education, employment, comorbidity, vaccination, region, and rurality characteristics of the eligible population according to the original 2013 USPSTF recommendations with the revised 2021 USPSTF recommendations using chi-squared tests. This study compared those originally eligible to those newly eligible using the BRFSS raking-dervived weighting variable. There were 30,190 study participants. The results of this study found that eligibility increased by 62.4% due to the revised recommendations. We found that the recommendation changes increased the proportion of eligible females (50.1% vs 44.1%), Black persons (9.2% vs 6.6%), Hispanic persons (4.4% vs 2.7%), persons aged 55-64 (55.8% vs 52.6%), urban-dwellers(88.3% vs 85.9%), unmarried (3.4% vs 2.5%) and never married (10.4% vs 6.6%) persons, as well as non-retirees (76.5% vs 56.1%) Respondents without comorbidities and COPD also increased. It is estimated that the revision of the lung cancer screening recommendations decreased eligibility disparities in sex, race, ethnicity, marital status, respiratory comorbidities, and vaccination status. Research will be necessary to estimate whether uptake patterns subsequently follow the expanded eligibility patterns.

New USPSTF Breast Cancer Screening Recommendations: A Talk With Task Force Vice Chair Dr John Wong.

In this video article, Dr. John B. Wong, Vice Chair of the U.S. Preventive Services Task Force (USPSTF), discusses implications of the new USPSTF recommendation for biennial screening mammography for women 40-74 years old.

Screening for Unhealthy Alcohol Use Among Patients With Multiple Chronic Conditions in Primary Care

IntroductionUnhealthy alcohol use (UAU) increases risk for and exacerbation of chronic health conditions. As such, screening, prevention, and management of UAU is especially critical to improving health outcomes for patients with multiple physical or mental chronic health conditions (MCC). It is unclear to what extent multiple chronic condition (MCC) status is a barrier to screening for UAU in the primary care setting. We hypothesized that patients with MCC would be at lower odds of being screened for UAU compared with patients with no MCC. MethodsWe performed a secondary analysis of electronic health record data for patients from 67 primary care practices in Virginia (2020-2023). Using the Center for Medicare and Medicaid Services’ chronic disease framework, we classified patients by MCC status: no MCC, physical MCC (P-MCC), mental health MCC (MH-MCC), and physical & mental health MCC (P&MH-MCC). We used multiple logistic regressions with an added practice-level random effect to analyze the relationship between MCC status and odds of receiving an alcohol-related assessment, of being screened for UAU with a U.S. Preventive Services Task Force (USPSTF)-recommended instrument, and of screening positive for UAU within the past 2 years. ResultsWithin a final cohort of n= 11,789, a total of 6796 patients (58%) had MCC (29% P-MCC, 4% MH-MCC, and 25% P&MH-MCC). In all, 69% of patients were screened for UAU, while 16% were screened with a USPSTF-recommended instrument and 7% screened positive for UAU. Relative to those with no MCC, patients with P&MH-MCC had 0.9 times lower odds of receiving any screening for UAU [95% CI: (0.8, 1.0), p = 0.0240], while patients with only P-MCC or only MH-MCC had similar odds. There was no difference in odds of being screened with a USPSTF-recommended instrument based on MCC status. Patients with MH-MCC and P&MH-MCC had 1.8 and 1.5 times greater odds, respectively, of screening positive for UAU [95% CI: (1.3, 2.7), p= 0.0014) and 95% CI: (1.2, 1.8), p=0.0003)]. ConclusionAlthough patients with chronic mental health conditions were more likely to screen positive for UAU than patients without MCC, Virginia primary care patients with P&MH MCC were less likely to receive an alcohol-related assessment during the past 2 years. Given the overall modest rate of screening with a USPSTF-recommended instrument, further efforts are needed to create the conditions for high quality alcohol-related preventive service delivery in primary care, particularly for patients with high complexity and/or mental health conditions.

Quality of Blood Pressure Monitoring During Telehealth Visits for Pregnant Patients at Risk of Preeclampsia.

Introduction: Preeclampsia is a significant cause of morbidity and mortality. The United States Preventative Services Task Force released 2023 recommendations encouraging more research on telehealth's role in facilitating blood pressure monitoring for patients with hypertensive disorders of pregnancy, including preeclampsia. This study evaluates the integration of self-measured blood pressure (SMBP) into telehealth obstetric visits during the COVID-19 pandemic for pregnant patients at risk of preeclampsia. Methods: A retrospective chart review was conducted of patients with one or more preeclampsia risk factors who delivered at a tertiary hospital from January to March 2021. Information pertaining to patients' number of antepartum, postpartum, and telehealth visits, blood pressure cuff access, and documentation of SMBP readings was recorded. Analyses were conducted in RStudio version 2022.12.0 + 353 (R Foundation for Statistical Computing). Results: Of 721 eligible patients, 244 (33.8%) had 2 or more ante- or postpartum telehealth visits. Of these 244 patients, 142 (58.2%) had chart documentation of owning a home blood pressure cuff. Only 106 (43.4%) had 1 or more SMBP documented in their telehealth visit notes, and they were more likely to have received care at federally qualified health centers than maternal fetal medicine clinics (p = 0.018) or private clinics (p < 0.001). Charts revealed no explanation for lack of blood pressure documentation during telehealth visits for most cases (n = 129, 93.5%). Conclusions: Opportunities exist to standardize blood pressure recording and documentation during telehealth visits, especially for patients with risk factors for preeclampsia, and to advocate for greater access to home blood pressure cuffs for all pregnant patients.

Unawareness of partner risk factors thwarts implementation of USPSTF recommendations for HIV pre-exposure prophylaxis in primary care

ABSTRACT The United States Preventive Services Task Force recommends pre-exposure chemoprophylaxis for persons at high risk of HIV exposure. The optimal screening strategy for at-risk individuals in primary care is not known. We evaluated the strategy of universal screening and discussed challenges to the implementation of this recommendation in primary care. Around 430 of 500 (86%) screening surveys were completed. Mutual monogamy was common but monogamous partners with recent negative HIV testing were uncommon. Likewise, among heterosexually active men and women, inconsistent condom use was common. Such individuals would be on guideline for HIV pre-exposure prophylaxis (PrEP) if their partner was at risk for HIV exposure. None of these potentially at-risk individuals met the criteria for PrEP, but 13% lacked knowledge of their partners' sexual and behavioral risk factors, preventing a clear decision on whether PrEP should be used. Our screen identified no individuals who clearly met the guideline criteria for HIV PrEP. We conclude that universal screening for HIV PrEP in primary care is unlikely to be an efficient strategy; targeted screening is likely more appropriate. Moreover, the 2019 guidelines for heterosexually active men and women rely on information that is often unknown to the patient, which makes these guidelines difficult to implement. Future guidelines should address these problems.