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Diagnosis and Treatment |

Preventive Care Guidelines: 1991

Robert S. A. Hayward, MD; Earl P. Steinberg, MD, MPP; Daniel E. Ford, MD, MPH; Michael F. Roizen, MD; and Keith W. Roach, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by a Health of the Public Grant from The Pew Charitable Trust and the Rockefeller Foundation and by the Alberta Heritage Foundation for Medical Research. Dr. Hayward is a Heritage Clinical Fellow and a Welch Center Fellow in Preventive Medicine.

Requests for Reprints: Earl P. Steinberg, MD, MPP, Program for Medical Technology and Practice Assessment, The Johns Hopkins University, 1830 East Monument Street, Room 8068, Baltimore, MD 21205.

Current Author Addresses: Drs. Hayward, Ford, and Steinberg: Division of Internal Medicine, The Johns Hopkins University, 1830 East Monument Street, 8th Floor, Baltimore, MD 21205.

Drs. Roizen and Roach: Department of Anesthesia and Critical Care, University of Chicago, 5841 South Maryland Avenue, Box 428, Chicago, IL 60637.

Ann Intern Med. 1991;114(9):758-783. doi:10.7326/0003-4819-114-9-758
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Clinicians increasingly are urged to integrate preventive services into their clinical practices. To facilitate this process, several groups have developed practice guidelines for preventing disease in asymptomatic patients. In this paper, we compare and contrast preventive guidelines from the American College of Physicians (ACP), the Canadian Task Force on the Periodic Health Examination (CTF), the United States Preventive Services Task Force (USPSTF), and other well-known authorities. We chose these groups because they based their recommendations on explicit methods that include critical appraisal of the pertinent literature. Recommendations from these authorities usually are consistent with each other. Moreover, the ACP, CTF, and USPSTF all favor a shift away from the relatively simple classification of patients by age and sex for general preventive interventions to the more complex stratification of patients by additional risk factors and the formulation of a selective prevention strategy that is specific to each risk profile. Some guidelines, particularly the criteria used to define patients who are at increased risk for preventable disease and who should have more intensive surveillance, are difficult to interpret. Further research is needed to address some areas of disagreement and ambiguity. In addition, new tools must be developed to help physicians apply preventive guidelines, particularly those that require noting many patient-specific characteristics.





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