Adopting Practice Guidelines on Screening

Often practitioners and developers of organized screening programs do not have the time, expertise, and resources needed to assess the merits of a proposed screening effort. Therefore, most practitioners rely on advice offered by credible organizations in the form of practice guidelines. Practice guidelines offer advice to clinicians, public health practitioners, managed-care organizations, and the public on how to improve the effectiveness and impact of clinical and public health interventions. Guidelines translate the findings of research and demonstration projects into accessible and usable information for public health practice. Guidelines for community- and clinic-based screening are published by many governmental and nongovernmental agencies, including associations of medical and health professionals. For example, guidelines on community screening for hypertension have been published periodically by the National High Blood Pressure Education Program since 1972 (NHBPEP 1993). And since 1989 the USPSTF has published a guide to clinical preventive services including recommendations for primary care practitioners on screening for 53 health conditions or risk factors in the context of a periodic health examination of asymptomatic persons (USPSTF 1996).

A guide for community preventive services is currently under development. The Centers for Disease Control and Prevention (CDC), in collaboration with other PHS agencies, will provide institutional and staff support to the recently created Task Force on Community Preventive Services. The guide is intended to complement the US Preventive Services Task Force Guide to Clinical Preventive Services by focusing on community-based prevention and control strategies. The guide will be based on best available scientific evidence and current expertise regarding essential public health services and effective methods of delivering those services. It will issue recommendations on the most effective and cost-effective community preventive services and methods for their implementation. This information is intended to help public health practitioners make informed choices on the most effective public health strategies, policies, and programs for their communities. An electronic database of the guide, including supporting evidence, is among the expected products of this activity.

When making decisions about screening in the community, most organizers and program sponsors adopt and then adapt authoritative recommendations from agencies that routinely develop or endorse practice guidelines. A potential user adopts a guideline by deciding to accept and implement the recommended practices. Often the guidelines are modified or adapted prior to implementation to meet the particular needs of practitioners and participants in each setting. The issues associated with adopting screening guidelines for use in a specific setting include desirable attributes of practice guidelines, adapting published guidelines to local needs, and dealing with controversial and conflicting guidelines.

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