USPSTF Clinical Guidelines in a Physician Assistant Curriculum (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

By Timothy Quigley, M.P.H., PA-C

On September 9, 2008, Timothy Quigley, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (714 KB).

Slide 1

U.S. Preventive Services Task Force (USPSTF) Clinical Guidelines in a Physician Assistant Curriculum

Timothy Quigley, M.P.H., PA-C
Associate Professor
Wichita State University

Slide 2

Physician Assistants (PAs)

• 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.

  Slide 3

  Board Exam Content: Health 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 patient's context.
  • Using informational databases.

  Slide 4

  AAPA Policy

  • .Physician assistants should routinely implement recommended clinical preventive services appropriate to the patient's 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.

  Slide 5

  USPSTF and AAPA

  • Long AAPA clinical partnership with USPSTF.
    • Also Healthy People (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.

  Slide 6

  Wichita State University (WSU) 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.

  Slide 7

  WSU PA Graduate Practice Settings, 1975-2006 (%)

  This graph demonstrates how WSU graduates compare to the national PA population. You will notice that we have a much higher percentage of graduates practicing in the underserved community (25% versus 12%), the primary care community (45% versus 35%), and in the rural practice setting (30% versus 15%).

  Slide 8

  USPSTF in the WSU PA Curriculum

  • History.
    • USPSTF formally incorporated into curriculum in 1995.
    • Now about 500 students skilled in it's utilization.
  • Texts.
    • Guide to Clinical Preventive Services required.
  • Online.
    • Especially for Rationale, Recommendation Statements and Evidence Review.
  • Homework.
    • Required searches in Guide and Web site.
  • Competency.
    • Working familiarity with Recommendations in Guide.
  • Personal Digital Assistants (PDAs).
    • Required for clinical rotations.
    • Linked to Electronic Preventive Services Selector through USPSTF.

  Slide 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 Web site and guide.

  Slide 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)?