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Featured Topic and Speakers
Featured Topic and Speakers
What is preventive screening? Does the USPSTF perform mental health screening? What are the best preventive screenings? And why screening adults for anxiety is now recommended. Our guest is Michael Barry, MD, chair of the U.S. Preventive Services Task Force. Todd Unger, AMA Chief Experience Officer, is the host.
Speaker
- Michael Barry, MD, Chairman of the US Preventive Services Task Force
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 this is the chair of the task force, Dr. Michael Barry of Boston. My name is Todd Unger, Chief Experience Officer at AMA in Chicago. Dr. Barry, welcome to the update.
Dr. Barry: It’s good to be with you and your audience, Todd.
Unger: Well, before we discuss specific topics, why don’t we start by getting an overview of the types of preventive services the task force is making recommendations for.
Dr. Barry: Of course. The task force makes evidence-based recommendations for preventive care to improve population health nationally. These recommendations cover disease screening, behavioral counseling, and preventative medications. We are 16 volunteer experts in primary prevention. And we’ve been making these recommendations since 1984. So this is our 40th anniversary.
Unger: Happy birthday. 40 is incredible. Tell us a little about the factors the task force considers when making or updating a recommendation.
Dr. Barry: Of course. We consider the burden of disease in the population. We deal with interventions that can be done in primary care because that’s really our focus. And these focus on people who don’t have signs and symptoms of the disease, at least those 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 the details, because there are a number of new recommendations. But for the purposes of this discussion, we’ll 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 should doctors know?
Dr. Barry: Depression and suicide are unfortunately all too common problems in the United States. But the good news is that there are simple and practical questionnaires that can screen for depression in primary care and identify people and follow them up, if necessary.
The task force therefore recommends that all adults, including pregnant and postpartum people, be screened for depression. However, we did not find sufficient evidence to recommend or not specific and separate screening for suicide risk. But we have called for more research on this important question.
Unger: All right. Well, there’s another new topic this year in terms of adult screening, that of anxiety. Tell us more about the recommendations on this.
Dr. Barry: Well, this is a new recommendation. And it reflects a growing awareness that anxiety is a common health problem that can cause considerable morbidity. I’m not talking about the occasional anxiety that we all experience from time to time, but the anxiety that becomes overwhelming, that interferes with people’s functioning and quality of life.
The working group therefore now recommends screening for anxiety disorders in adults under 65, always using simple and practical questionnaires. We did not have enough evidence to recommend or not recommend screening for anxiety in people 65 and older. It’s not that they can’t feel anxiety, it’s just that there wasn’t enough evidence to recommend or not recommend screening this older group.
Unger: Are these screening questions somehow built into the EHR? Or how does it actually work during an office visit?
Dr. Barry: Different practices may do them differently. Sometimes a medical assistant can administer them. The clinician can do this themselves. So they are really adaptable to different situations.
Unger: All right. We talked about depression, anxiety screenings. Let’s look at another type of recommendation. And this one is about taking PrEP to prevent HIV. Tell us more about it.
Dr. Barry: Well, HIV infection continues to be a significant public health problem. In the United States, approximately 1.2 million people are living with HIV. And every year, more and more people become infected with HIV.
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 in pill or injection form. And should be combined with other safe sex practices such as regular use of condoms. The task force therefore recommends that adults and adolescents at increased risk of HIV infection take PrEP to avoid contracting HIV.
And the risk factors for infection, as you might imagine, would be sex with a partner who has known HIV, a recent sexually transmitted infection, not using condoms regularly, which we certainly recommend people to do, because it is important to combine this with anti-HIV PrEP. .
Unger: Absolutely. All right. Well, let’s move on to our fourth recommendation. This is intended to screen for hypertension in pregnant women. What should doctors know about this task force recommendation?
Dr. Barry: Well, as I’m sure you know, maternal and fetal morbidity and mortality remain a major problem in the United States. And that burden is disproportionately shouldered by Black, American Indian, and Alaska Native people in our country.
The task force recommends that all pregnant women have their blood pressure measured at every prenatal visit because we can identify hypertensive disorders of pregnancy and prevent complications from sustained gestational hypertension, and even more worrisome, preeclampsia. and eclampsia, where this blood pressure elevation can begin to cause organ damage. And these outcomes can be avoided with early identification and proper treatment.
Unger: Well, this discussion on these four that we covered here in the update has been incredibly informative. Where can doctors find all the latest recommendations from the U.S. Preventive Services Task Force?
Dr. Barry: Well, there are many ways to stay updated with us. It all starts with installing the US Preventive Services Task Force in your favorite browser. You will arrive on our website. All our recommendations are there. And you can sign up for our Prevention Task Force app so you can have all of our recommendations at your fingertips.
Our recommendations are of course published in the Journal of the American Medical Association, so that’s another good source. You can also sign up on the website to receive regular email updates. Or you can follow us on LinkedIn, if you prefer. So many ways to stay in touch.
Unger: And just to make things easier, we’ll put a link to this site in the description of this episode. Dr. Barry, thank you very much for joining us today and keeping doctors informed. As a partner in the U.S. Preventive Services Task Force, the AMA helps promote these recommendations and train physicians to put them into practice. If you would like to support the AMA’s efforts to educate physicians, you can support us by joining the AMA at ama-assn.org/join.
That concludes today’s episode. And we will be back soon with another AMA update. You can subscribe to all new episodes and find all our videos and podcasts on ama-assn.org/podcasts. Thanks for joining us today. Please be careful.
Disclaimer: The views expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
