Family physicians have come to rely on the US Preventive Services Task Force (USPSTF) for rigorous, evidence-based recommendations on the use of clinical preventive services. Still, many such services reach too few individuals who need them. And that’s where the less well known Community Preventive Services Task Force comes in. The CPSTF makes recommendations regarding public health interventions and ways to increase the use of preventive services in the clinical setting—eg, means of improving childhood immunization rates or increasing screening for cervical, breast, and colon cancer.
To better understand how the CPSTF can serve as a resource to busy family physicians, it’s helpful to first understand a bit about the inner-workings of the CPSTF itself.
How CPSTF figures out what works
Formed in 1996, the CPSTF consists of 15 independent, nonfederal members with expertise in public health and preventive medicine, appointed by the Director of the Centers for Disease Control and Prevention (CDC). The Task Force makes recommendations and develops guidance on which community-based health promotion and disease-prevention interventions work and which do not, based on available scientific evidence. The Task Force uses an evidence-based methodology similar to that of the USPSTF—ie, assessing systematic reviews of the evidence and tying recommendations to the strength of the evidence. However, the Task Force has only 3 levels of recommendations: recommend for, recommend against, and insufficient evidence to recommend.
Three CPSTF meetings are held each year, and a representative from the American Academy of Family Physicians (AAFP) attends as a liaison, along with liaisons from other organizations with an interest in the methods and recommendations. The CDC provides the CPSTF with technical and administrative support. However, the recommendations developed do not undergo review or approval by the CDC and are the sole responsibility of the Task Force.
The recommendations made are contained in the Guide to Community Preventive Services, often called The Community Guide, which is available on the Task Force’s Web site at www.thecommunityguide.org/index.html. The topics on which the CPSTF currently has recommendations are listed in TABLE 1. (Since community-wide recommendations are rarely subjected to controlled clinical trials, methods of assessing and ranking other forms of evidence are required. To learn more about how the CPSTF approaches this, see: https://www.thecommunityguide.org/about/our-methodology.)
Improving immunization rates
The topic of immunizations is an example of how synergistic the CPSTF recommendations can be with those from clinical organizations. The Advisory Committee on Immunization Practices (ACIP) makes recommendations on the use of vaccines.1 The CPSTF has developed a set of recommendations on how to increase the uptake of vaccines to improve rates of immunization.2 Interventions they recommend include vaccine requirements for attendance at preschool, primary and secondary school, and college; patient reminder and recall systems; patient and family incentives and rewards; providing vaccines at Women, Infants, and Children clinics, schools, work sites, and homes; standing orders for vaccine administration; physician reminders; physician assessments and feedback; reducing out-of-pocket expenses for vaccines; and using immunization registries. Just as important, the CPSTF identifies interventions that lack hard evidence to support their effectiveness.