USPSTF Clinical Guidelines in a Physician Assistant Curriculum

1
USPSTF Clinical Guidelines in a Physician
Assistant Curriculum

• Timothy Quigley, MPH, PA-C
• Associate Professor
• Wichita State University

2
Physician Assistants

• History
• First class of Navy corpsmen started in 1965
• Function
• PAs practice medicine under physician supervision
• Numbers
• 68,000 in clinical practice in 2008
• Education
• 141 accredited programs
• Typical 24-32 months long Masters degree

• National Organization
• American Academy of Physician Assistants (AAPA)
• 40,000 dues paying members
• Legal
• All states authorize PA practice including
  prescribing
• Certification after PA education and board exam

3
Board Exam ContentHealth Maintenance (10)

• Knowledge of
• Epidemiology of selected medical conditions
• Early detection and prevention of selected
  medical conditions
• Relative value of common screening tests
• Appropriate patient education regarding
  preventable conditions or lifestyle modifications
  
• Prevention of communicable diseases
• Immunization schedules and recommendations for
  infants, children, adults and foreign travelers
• Risks and benefits of immunization

• Cognitive Skills in
• Using counseling and patient education techniques
  
• Communicating effectively with patients to
  enhance health maintenance
• Adapting health maintenance to the patients
  context
• Using informational databases

4
AAPA Policy

• Physician assistants should routinely implement
  recommended clinical preventive services
  appropriate to the patients age, gender, race
  and individual risk profile.
• Preventive services offered to patients should
  be supported by scientific criteria that
  demonstrate clinical effectiveness.
• To offer effective clinical preventive services
  to their patients, it is important that PAs
  become familiar and stay current with
  authoritative clinical preventive services
  guidelines and recommendations.

5
USPSTF and AAPA

• Long AAPA clinical partnership with USPSTF
• Also HP 2010, Partnership for Prevention and Task
  Force on Community Preventive Services
• Recently (Summer 2008) AAPA helped distribute
  15,000 copies of Guide to Clinical Preventive
  Services to PAs practicing in
• Family Medicine
• General Internal Medicine
• General Pediatrics
• Obstetrics and Gynecology

6
Wichita State University PA Program

• History
• First class started in 1973
• Focus on rural primary care
• Students
• 84 students
• 42 in didactic training
• 42 in clinical training
• Graduates
• 1,200 graduates
• 45 in primary care
• 30 rural
• 25 medically underserved.

7
WSU PA Graduate Practice Settings, 1975-2006 ()
Source AAPA, 2007 n1117
8
USPSTF in the WSU PA Curriculum

• History
• USPSTF formally incorporated into curriculum in
  1995
• Now about 500 students skilled in its
  utilization
• Texts
• Guide to Clinical Preventive Services required
• Online
• Especially for Rationale, Recommendation
  Statements and Evidence Review

• Homework
• Required searches in Guide and website
• Competency
• Working familiarity with Recommendations in Guide
• Personal Digital Assistants (PDAs)
• Required for clinical rotations
• Linked to Electronic Preventive Services Selector
  through USPSTF

9
Why We Value USPSTF Guidelines

• Independence of members
• Experts in prevention and primary care
• Rigorous evaluations of the literature
• Transparency of the scientific evidence
• Impartiality of panel and recommendations
• Broad spectrum of recommendations for primary
  care (Screening, Counseling, Chemoprophylaxis)
• Clarity of Recommendations and Rationale
• User-friendly website and guide

10
Unanswered Questions

• Use in Clinical Practice
• How frequently do PA students and PA grads
  utilize the Guide or EPS
• Use in Patient Education
• Resources to discuss/explain recommendations
• How do PA clinicians decide on which preventive
  service to offer (and when)