Clinical Preventive Medicine
An Evaluation of Annual Adherence to Lung Cancer Screening in a Large National Cohort
Lung cancer screening reduces mortality in large RCTs where adherence is high. Unfortunately, recently published adherence rates do not replicate those seen in trials. Previous publications support a centralized approach to ensure patient eligibility and improve adherence.Video Telehealth Access and Changes in HbA1c Among People With Diabetes
Video telehealth can offer people convenient, real-time access to clinicians without arranging transportation or time off work. Among people with diabetes, this study examines the association between video telehealth access and changes in HbA1c.Evaluation of a Pharmacists’ Patient Care Process Approach for Hypertension
An estimated 116 million American adults (47.3%) have hypertension. Most adults with hypertension do not have it controlled—3 in 4 (92.1 million) U.S. adults with hypertension have a blood pressure ≥130/80 mmHg. The Pharmacists’ Patient Care Process is a standardized patient-centered approach to the provision of pharmacist care that is done in collaboration with other healthcare providers. Through the Michigan Medicine Hypertension Pharmacists’ Program, pharmacists use the Pharmacists’ Patient Care Process to provide hypertension management services in collaboration with physicians in primary care and community pharmacy settings.Tobacco Treatment Specialist Training for Lung Cancer Screening Providers
On the basis of the results of the National Lung Screening Trial,1 the U.S. Preventive Services Task Force (USPSTF) recommends lung cancer screening with a low-dose computed tomography (LDCT) scan as a screening tool for early detection of lung cancer.2 More specifically, this LDCT scan is recommended for high-risk individuals who have at least a 20-pack-year smoking history, who are currently smoking or have quit in the last 15 years, and who are aged 50–80 years.2 At the time of writing this paper, the Centers for Medicare and Medicaid Services (CMS) approved annual lung cancer screening as a covered benefit for those patients who meet the criteria outlined in the 2013 USPSTF recommendation (i.e., have 30-pack-year history and aged 55–77 years).When to Discuss Prostate Cancer Screening With Average-Risk Men
In the U.S. in 2021, nearly 200,000 men will be diagnosed with prostate cancer, and >30,000 will die of the disease.1 Although RCTs have shown that prostate-specific antigen (PSA) screening reduces prostate cancer deaths,2,3 screening carries significant risks of harm and limited absolute benefit over a 10-year horizon.4,5 Given this background, clinical guidelines agree that PSA screening should only be offered to men who indicate a preference for screening after shared decision making with their providers.Understanding the Value of the Wellness Visit: A Descriptive Study
Clinical preventive services can reduce mortality and morbidity, but Americans receive only half of the recommended care. Although wellness visits protect time for clinicians to review needs and discuss care with patients, studies have not shown that having a wellness visit improves health outcomes. This study seeks to understand the types of discussions and volume of care delivered during wellness visits.A Pilot Study Examining the Efficacy of Delivering Colorectal Cancer Screening Messages via Virtual Health Assistants
Patients are more likely to complete colorectal cancer screening when recommended by a race-concordant healthcare provider. Leveraging virtual healthcare assistants to deliver tailored screening interventions may promote adherence to colorectal cancer screening guidelines among diverse patient populations. The purpose of this pilot study is to determine the efficacy of the Agent Leveraging Empathy for eXams virtual healthcare assistant intervention to increase patient intentions to talk to their doctor about colorectal cancer screening.U.S. Preventive Services Task Force Update and Computed Tomography for Colorectal Cancer Screening Among Privately Insured Population
The Affordable Care Act of 2010 mandated private health plans to fully cover the services recommended by the U.S. Preventive Services Task Force. In June 2016, the Task Force added computed tomography colonography to its list of recommended tests for colorectal cancer screening. This study evaluates the association among the updated recommendation, patient cost-sharing obligations, and the uptake of colorectal cancer screening through computed tomography colonography in the privately insured population.Exposure to Weight Management Counseling Among Students at 8 U.S. Medical Schools
Clinical guidelines support physician intervention consistent with the Ask, Advise, Assess, Assist, Arrange framework for adults who have obesity. However, weight management counseling curricula vary across medical schools. It is unknown how frequently students receive experiences in weight management counseling, such as instruction, observation, and direct experience.Addiction Medicine After COVID-19: The Imperative of a Trained Workforce
Amid the ongoing coronavirus disease 2019 (COVID-19) pandemic, substance use disorder (SUD) remains a pressing issue in the U.S. According to the latest National Survey on Drug Use and Health, the number of Americans afflicted with SUD exceeds 20 million, an estimated 2 million of whom are coping with an opioid use disorder (OUD).1 The efficacy of evidence-based opioid agonist therapy with methadone or buprenorphine notwithstanding, the vast majority of Americans living with OUD do not receive any treatment.Family Health History–Based Cancer Prevention Training for Community Health Workers
Cancer is the second leading cause of death in the U.S. Utilizing family health history in cancer prevention holds promise in lessening the burden of cancer. Nevertheless, family health history is underutilized in public health and preventive medicine. Community health workers, also known as lay health educators, are ideal candidates to offer basic cancer family history–based education and services to the general public. The authors developed the first cancer family history–based genomics training program in cancer prevention tailored for community health workers.The Relationship Between Health Literacy and Nonrecommended Cancer Screening
Health literacy affects how patients behave within the healthcare system. Overutilization of screening procedures inconsistent with the U.S. Preventive Services Task Force guidelines contributes to the high cost of health care. The authors hypothesize that higher health literacy supports guideline-concordant screening. This study assesses the effect of health literacy on nonrecommended prostate, breast, and cervical cancer screening in patients older than the recommended screening age limit.Familiarity With and Use of Insufficient Evidence Findings From the Community Preventive Services Task Force
The Community Preventive Services Task Force (CPSTF) is an independent, nonfederal panel of experts that uses systematic reviews to develop recommendations about community preventive services and programs to improve population health. The CPSTF issues an insufficient evidence (IE) finding when the evidence is lacking, inconsistent, or has significant methodologic limitations. An IE finding indicates a need for more research.1 The NIH partners with the Centers for Disease Control and Prevention Community Guide Office to support the CPSTF in making evidence-based recommendations and identifying research gaps.Improving Patient Engagement Through Patient Decision Support
During the past decade, patient engagement has been the buzz phrase of health information technology, with dozens of vendors offering text message interventions, smartphone applications (apps), electronic patient portals, and other patient-facing software innovations. These technologies crunch data to deliver targeted health advice and promise better outcomes, lower costs, and higher satisfaction. However, a closer look at the burgeoning and diverse array of patient-facing technologies reveals that each operationalizes patient engagement differently.Early- and Late-Stage Cancer Diagnosis Under 3 Years of Medicaid Expansion
Health insurance expansions may increase early detection of cancer and reduce late-stage cancer incidence. The study assesses the effects of the Affordable Care Act Medicaid expansions on rates of early- and late-stage cancer diagnosis up to 3 years after implementation.Pediatric Resident Training in Tobacco Control and the Electronic Health Record
Given the dangers posed by tobacco use and tobacco smoke exposure, pediatricians should address tobacco use and exposure with patients and parents at every opportunity, but this is not consistently done in practice. One reason may be that many medical residents do not receive education on how to address tobacco use and tobacco smoke exposure with patients and their parents. In a 2012 survey of U.S. pediatric program directors, 65% of programs reported covering tobacco control in their curricula, but most training programs focused on tobacco's health effects and not intervention strategies for clinical practice.Revolutionized Public Health Teaching to Equip Medical Students for 21st Century Practice
Medical graduates increasingly need public health skills to equip them to face the challenges of healthcare practice in the 21st century; however, incorporating public health learning within medical degrees remains a challenge. This paper describes the process and preliminary outcomes of the transformation, between 2016 and 2019, of a 5-week public health module taught within an undergraduate medical degree in New Zealand. The previous course consisted of a research project and standalone lectures on public health topics.Breast Cancer Screening via Digital Mammography, Synthetic Mammography, and Tomosynthesis
Screening mammography reduces breast cancer mortality, although physicians and patients can be overwhelmed by the multiple screening guidelines, multiple mammography modalities, and the benefits of different approaches.1–3 A recent improvement to conventional digital mammography (DM) is digital breast tomosynthesis (DBT), also known as 3D mammography, a three-dimensional image data set reconstructed from low-dose x rays. Adding DBT to DM (DM-DBT) limits false positives and improves cancer detection rates compared with DM alone,4 although DM-DBT delivers almost 2.25 times the radiation of DM.Precision Medicine and Precision Public Health: Academic Education and Community Engagement
Precision medicine (PM) approaches are increasingly included in everyday medical practice. Simultaneously, public health leaders advocate for using related methods to establish “precision public health” (PPH). Academic health centers (AHCs) drive the science that enables these innovations and often pioneer putting them into practice. However, the rise of PM and PPH also affects AHC education and community engagement missions. Several salient opportunities were identified.Lung Cancer Screening Utilization: A Behavioral Risk Factor Surveillance System Analysis
Lung cancer is the leading cause of cancer-related death in the U.S. The National Lung Screening Trial found that low-dose computed tomography reduced lung cancer mortality in high-risk individuals. As a result, the U.S. Preventive Services Task Force began recommending low-dose computed tomography screening for those at a high risk in 2013. Therefore, it is imperative to continually monitor lung cancer screening uptake. The objective of this study was to determine computed tomography screening uptake across ten states using 2017 Behavioral Risk Factor Surveillance System survey data.Including Lifestyle Medicine in Medical Education: Rationale for American College of Preventive Medicine/American Medical Association Resolution 959
Introduced by the American College of Preventive Medicine and released by the American Medical Association House of Delegates in 2017, Resolution 959 (I-17) supports policies and mechanisms that incentivize and/or provide funding for the inclusion of lifestyle medicine education and social determinants of health in undergraduate, graduate and continuing medical education. Resolution 959 was passed to help address the current healthcare costs of lifestyle-related, noncommunicable chronic diseases that exert a devastating economic burden on the U.S.Alignment of Preventive Medicine Physicians’ Residency Training With Professional Needs
Preventive medicine (PM) physicians promote population-based approaches to health care with training that emphasizes public health, epidemiology, and policy. PM physicians use these skills in varied, often nonclinical, practice settings. PM career diversity challenges educators when designing residency curricula. Input from PM physicians about workforce environments is needed to ensure that residency requirements match skills needed post-residency. Graduates of one PM residency were sent a cross-sectional survey in 2016.Temporal Patterns in Chlamydia Repeat Testing in Massachusetts
National guidelines recommend test-of-cure for pregnant women and test-of-reinfection for all patients with chlamydia infections in order to interrupt transmission and prevent adverse sequelae for patients, partners, and newborns. Little is known about retesting and positivity rates, and whether they are changing over time, particularly in private sector practices.The Emerging Identity of the Preventive Medicine Specialty: A Model for the Population Health Transition
The emergent identity of the specialty area of public health and general preventive medicine (PH-GPM),1 referred to as preventive medicine (PM) in this paper, spawns from several historical and contemporary trends. The tripartite birth of the specialty, resulting in its three specialty areas with distinct names (i.e., PH and aerospace medicine in 1949, occupational medicine in 1953, GPM in 1957, and its merger with PH in 1983 for examination purposes),2 makes any unified branding attempt challenging.Prevalence and Correlates of Diabetes Prevention Program Referral and Participation
As the burden of type 2 diabetes rises, there is increasing focus on improving the reach of evidence-based lifestyle interventions. Using nationally representative data, this study identifies how frequently at-risk adults are being referred to and participating in diabetes prevention programming, and explores correlates of referral, participation, and interest.
