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Featured topic and speakers
What is a preventive screening? Does USPSTF screen for mental health? What are the best preventive screenings? Plus, why an anxiety screening for adults is now recommended. Our guest is Michael Barry, MD, chair of the U.S. Preventive Services Task Force. AMA Chief Experience Officer Todd Unger hosts.
- USPSTF anxiety screening tool (PDF).
- Check the latest U.S. Preventive Services Task Force recommendations.
- U.S. Preventive Services Task Force Recommendation on screening for speech and language delay and disorders in children.
- Access The Journal of the American Medical Association.
- Call or text 9-8-8 if you or anyone you know needs help. The National Suicide Prevention Lifeline is now: 988 Suicide and Crisis Lifeline. It provides free 24/7 confidential support for people in distress, crisis resources for you or your loved ones, and best practices for professionals in the U.S. Visit https://988lifeline.org/ for more.
- The AMA is your powerful ally in patient care. Join now.
Speaker
- Michael Barry, MD, chair, U.S. Preventive Services Task Force
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about important new recommendations from the U.S. Preventive Services Task Force on screening for depression, anxiety and more. Joining me to discuss is the chair of the task force, Dr. Michael Barry in Boston. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Barry, welcome to the update.
Dr. Barry: Good to be with you and your audience, Todd.
Unger: Well, before we discuss specific topics, why don't we just start by getting an overview of the types of preventive services that the task force issues recommendations for.
Dr. Barry: Sure. The task force makes evidence-based recommendations for preventive care to improve the health of people nationwide. Those recommendations cover disease screening, behavioral counseling and preventive medicines. We're 16 volunteer experts in primary care prevention. And we've been making these recommendations since 1984. So it's our 40th anniversary.
Unger: Happy anniversary. 40, that's amazing. Tell us a little bit about the factors that the task force considers when making or updating a recommendation.
Dr. Barry: Sure. We consider the burden of disease in the population. We deal with interventions that can be delivered in primary care because that's really our focus. And these are focused on people who don't have signs and symptoms of the disease, at least that are recognized. So we're really talking about screening asymptomatic people or people who don't realize they have a problem.
Unger: All right. Well, let's get into more specifics, because there are a number of new recommendations. But for the purposes of this discussion, we're going to focus on four of the most notable ones. And let's start with the topic of screening for depression and suicide risk in adults. What do physicians need to know?
Dr. Barry: So depression and suicide are unfortunately all too common problems in the United States. But the good news is there are simple, practical questionnaires that can screen for depression in primary care and get people identified and into treatment, if need be.
So the task force recommends all adults, including pregnant and postpartum people, be screened for depression. We didn't find enough evidence, though, to recommend for or against specifically and separately screening for suicide risk. But we've called for more research on that important question.
Unger: All right. Well, there's another new topic this year in terms of adult screening, and that's for anxiety. Tell us more about the recommendations on that.
Dr. Barry: Well, this is a new recommendation. And it reflects increasing appreciation that anxiety is a common health problem that can create considerable morbidity. Now I'm not talking about the occasional anxiety that we all have from time to time, but it's anxiety that becomes overwhelming, that interferes with people's functioning and quality of life.
So the task force now recommends screening adults under 65 for anxiety disorders, again with simple, practical questionnaires. We didn't have enough evidence to recommend for or against screening for anxiety in people 65 and older. It's not that they can't have anxiety, it's that there just wasn't enough evidence to recommend for or against screening that older group.
Unger: Are those screening questions kind of worked into the EHR? Or how does that actually transpire in an office visit?
Dr. Barry: Different practices can do them differently. Sometimes a medical assistant can administer them. The clinician can themselves. So they're really adaptable to different situations.
Unger: All right. We talked about depression, anxiety screenings. Let's look at a different kind of recommendation. And this one is about taking PrEP to prevent HIV. Tell us more about that.
Dr. Barry: Well, HIV infection continues to be a significant public health issue. There are about 1.2 million people in the United States living with HIV. And more people develop HIV infection each year.
The good news is that Pre-Exposure Prophylaxis, or PrEP, is a very effective way to prevent HIV infection. HIV PrEP can be taken regularly as a pill or an injection. And should be combined with other safe sex practices such as regular use of condoms. So task force recommends adults and adolescents at increased risk of HIV infection should take PrEP to prevent acquiring HIV.
And risk factors for infection, as you could imagine, would be sex with a partner that has known HIV, a recent sexually transmitted infection, not using condoms consistently, which we would certainly recommend that people do, because that's important to combine with HIV PrEP.
Unger: Absolutely. All right. Well, let's move on to our fourth recommendation. This one is for screening pregnant people for hypertension. What do physicians need to know about this recommendation from the task force?
Dr. Barry: Well, as I'm sure you know, maternal and fetal morbidity and mortality remains a large problem in the United States. And this burden is disproportionately shouldered by Black, Native American and Alaskan Native people in our country.
The task force recommends all pregnant people should have their blood pressure measured at each prenatal visit, as we can identify hypertensive disorders of pregnancy and prevent complications due to sustained gestational hypertension, and even more worrisome, pre-eclampsia and eclampsia, where that blood pressure elevation can begin to cause organ damage. And those outcomes can be precluded with early identification and appropriate treatment.
Unger: Well, this discussion just of these four that we covered here in the update was incredibly informative. Where can physicians go to read all the latest recommendations from the U.S. Preventive Services Task Force?
Dr. Barry: Well, there's a lot of ways to stay up to date with us. It all starts with putting U.S. Preventive Services Task Force in your favorite browser. You'll get to our website. All our recommendations are there. And you can sign up for our Prevention Task Force app so you can have all our recommendations at your fingertips.
Our recommendations are published in, of course, the Journal of the American Medical Association, so that's another good source. You can also, on the website, sign up for regular email updates. Or you can follow us on LinkedIn, if you prefer. So lots of ways to stay in touch.
Unger: And just to make it easy, we'll put a link to that site in the description of this episode. Dr. Barry, thanks so much for joining us today and keeping physicians up to date. As a partner of the U.S. Preventive Services Task Force, the AMA helps to promote these recommendations and educate physicians to put them into practice. If you want to support AMA's efforts to educate physicians, you can support us by joining the AMA at ama-assn.org/join.
That wraps up today's episode. And we'll be back soon with another AMA Update. You can subscribe for all new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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