Douglas K. Owens, MD, MS; Jeremy D. Goldhaber-Fiebert, PhD
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, U.S. government, or USPSTF.
Financial Support: Dr. Owens is supported by the Department of Veterans Affairs. Dr. Goldhaber-Fiebert is supported by a National Institutes of Health career development award (K01 AG037593).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1497.
Requests for Single Reprints: Douglas K. Owens, MD, MS, Center for Primary Care and Outcomes Research and Center for Health Policy, Stanford University, 117 Encina Commons, Stanford, CA 94305-6019; e-mail, email@example.com.
Current Author Addresses: Drs. Owens and Goldhaber-Fiebert: 117 Encina Commons, Stanford, CA 94305.
Owens D., Goldhaber-Fiebert J.; Prioritizing Guideline-Recommended Interventions. Ann Intern Med. 2013;159:223-224. doi: 10.7326/0003-4819-159-3-201308060-00014
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Published: Ann Intern Med. 2013;159(3):223-224.
Imagine that a new patient named “Bill,” who is aged 62 years, comes to your clinic for a visit. You want to deliver guideline-recommended preventive care and decide to use the U.S. Preventive Services Task Force (USPSTF) guidelines. More than 10 separate guidelines are relevant to Bill. Following the guidelines, you screen for hypertension, hyperlipidemia, colon cancer, depression, alcohol misuse, depression, diabetes, HIV, obesity, and tobacco use. You learn that Bill is obese; smokes; and has high cholesterol, hypertension, and diabetes. Given his risk factors, USPSTF guidelines indicate that Bill would be eligible for aspirin use to prevent cardiovascular disease; management of obesity, diabetes, and hypertension; and possibly counseling to promote a healthy diet and physical activity. Although the goal is to follow all of the guideline recommendations, it simply may not be possible to do everything. If that is true, which of these guideline-recommended interventions are most important? Will smoking cessation, treatment of diabetes, or weight loss improve Bill's health the most? How can we know, and what metric should we use to decide which interventions provide the most benefit?
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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