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EVIDENCE BASED RECOMMENDATIONS FOR PREVENTIVE SERVICES
CLINICAL SERVICES 
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Clinical Preventive Services

The ACPM and the U.S. Preventive Services Task Force (USPSTF), based at the Agency for Healthcare Research and Quality, have each developed evidence-based recommendations regarding the delivery of clinical preventive services. Click on the topic to see the related recommendations.

Screening ½ Counseling ½ Immunizations and Chemoprophylaxis

Screening

Cardiovascular Diseases
Abdominal Aortic Aneurysm
Asymptomatic Carotid Artery Stenosis
Asymptomatic Coronary Artery Disease
High Blood Cholesterol and Other Lipid Abnormalities
Hypertension
Peripheral Arterial Disease

Congenital Disorders
Congenital Hypothyroidism
Down Syndrome
Hemoglobinopathies
Neural Tube Defects, Including Folic Acid/Folate Prophylaxis
Phenylketonuria

Infectious Diseases
Asymptomatic Bacteriuria
Chlamydial Infection, Including Ocular Prophylaxis in Newborns
Genital Herpes Simplex
Gonorrhea, Including Ocular Prophylaxis in Newborns
Hepatitis B Virus Infection
Human Immunodeficiency Virus Infection
Rubella, Including Immunization of Adolescents and Adults
Syphilis
Tuberculous Infection, Including Bacille Calmette-Guerin Immunization

Mental Disorders and Substance Abuse
Dementia
Depression
Drug Abuse
Family Violence
Problem Drinking
Suicide Risk

Metabolic, Nutritional, and Environmental Disorders
Diabetes Mellitus
Elevated Lead Levels in Childhood and Pregnancy
Iron Deficiency Anemia, Including Iron Prophylaxis
Obesity
Thyroid Disease

Musculoskeletal Disorders
Adolescent Idiopathic Scoliosis
Postmenopausal Osteoporosis

Neoplastic Diseases
Bladder Cancer
Breast Cancer
Cervical Cancer
Colorectal Cancer
Lung Cancer
Oral Cancer
Ovarian Cancer
Pancreatic Cancer
Prostate Cancer
Skin Cancer
Testicular Cancer
Thyroid Cancer

Prenatal Disorders
D (Rh) Incompatibility
Home Uterine Activity Monitoring
Intrapartum Electronic Fetal Monitoring
Preeclampsia
Ultrasonography in Pregnancy

Vision and Hearing Disorders
Glaucoma
Hearing Impairment
Visual Impairment

Counseling

Dental and Periodontal Disease
Gynecologic Cancers
Healthy Diet
HIV Infection, and Other Sexually Transmitted Diseases
Household and Recreational Injuries
Low Back Pain
Motor Vehicle Injuries
Physical Activity
Tobacco Use
Unintended Pregnancy
UV Light Exposure
Youth Violence

Immunizations and Chemoprophylaxis

Adult Immunizations, Including Chemoprophylaxis Against Influenza A
Aspirin Prophylaxis for the Primary Prevention of Myocardial Infarction
Aspirin Prophylaxis in Pregnancy
Childhood Immunizations
Postexposure Prophylaxis for Selected Infectious Diseases
Postmenopausal Hormone Prophylaxis

 

Clinical Preventive Services -
Screening - Cardiovascular Diseases -

Abdominal Aortic Aneurysm

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against routine screening of asymptomatic adults for abdominal 
aortic aneurysm with abdominal palpation or ultrasound.


Clinical Preventive Services -
Screening -Cardiovascular Diseases -

Asymptomatic Carotid Artery Stenosis

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against screening asymptomatic persons for carotid artery stenosis 
using the physical examination or carotid ultrasound. For selected high-risk patients, a recommendation to discuss the 
potential benefits of screening and carotid endarterectomy may be made on other grounds. All persons should be 
screened for hypertension and clinicians should provide counseling about smoking cessation.


Clinical Preventive Services -
Screening - Cardiovascular Diseases -

Asymptomatic Coronary Artery Disease

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against screening middle-aged and older men and women for 
asymptomatic coronary artery disease, using resting electrocardiography (ECG), ambulatory ECG, or exercise ECG. 
Recommendations against routine screening can be made on other grounds for individuals who are not at high risk 
of developing clinical heart disease (see Clinical Intervention). Routine screening is not recommended as part of the 
periodic health visit or pre-participation sports examination for children, adolescents, or young adults. Clinicians 
should emphasize proven measures for the primary prevention of coronary disease (see Clinical Intervention).

 

Clinical Preventive Services -
Screening - Cardiovascular Diseases -

High Blood Cholesterol and Other
Lipid Abnormalities

U.S. Preventive Services Task Force Recommendations:

Periodic screening for high blood cholesterol is recommended for all men ages 35-65 and women ages 45-65. There is insufficient evidence to recommend for or against routine screening of asymptomatic persons over age 65, but recommendations to screen healthy men and women ages 65-75 may be made on other grounds (see Clinical Intervention). There is also insufficient evidence to recommend for or against routine screening in children, adolescents, or young adults. Recommendations for screening adolescents and young adults with risk factors for coronary disease, and against routine screening in children, may be made on other grounds (see Clinical Intervention). There is insufficient evidence to recommend for or against routine screening for other lipid abnormalities. All patients should receive periodic screening and counseling regarding other measures to reduce their risk of coronary disease (see
Screening for Hypertension;  Counseling to Prevent Tobacco Use;  Counseling to Promote Physical Activity;  and Counseling to Promote a Healthy Diet)
 

 

Clinical Preventive Services -
Screening - Cardiovascular Diseases -

Hypertension

U.S. Preventive Services Task Force Recommendations:

Screening for hypertension is recommended for all children and adults (see Clinical Intervention).

 

Clinical Preventive Services -
Screening - Cardiovascular Diseases -

Peripheral Arterial Disease

U.S. Preventive Services Task Force Recommendations:

Routine screening for peripheral arterial disease in asymptomatic persons is not recommended. Clinicians should be alert to symptoms of peripheral arterial disease in persons at increased risk (see Clinical Intervention) and should evaluate patients who have clinical evidence of vascular disease.

 

Clinical Preventive Services -
Screening - Congenital Disorders -

Congenital Hypothyroidism

U.S. Preventive Services Task Force Recommendations:

Screening for congenital hypothyroidism with thyroid function tests on dried-blood spot specimens is recommended for all newborns in the first week of life (see Clinical Intervention).

 

Clinical Preventive Services -
Screening - Congenital Disorders -

Down Syndrome

U.S. Preventive Services Task Force Recommendations:

The offering of amniocentesis or chorionic villus sampling (CVS) for chromosome studies is recommended for pregnant women at high risk for Down syndrome. The offering of screening for Down syndrome by serum multiple-marker testing is recommended for all low-risk pregnant women, and as an alternative to amniocentesis and CVS for high-risk women (see Clinical Intervention). This testing should be offered only to women who are seen for prenatal care in locations that have adequate counseling and follow-up services. There is currently insufficient evidence to recommend for or against screening for Down syndrome by individual serum marker testing or ultrasound examination, but recommendations against such screening may be made on other grounds (see Clinical Intervention).

Clinical Preventive Services -
Screening - Congenital Disorders -

Hemoglobinopathies

U.S. Preventive Services Task Force Recommendations:

Neonatal screening for sickle hemoglobinopathies is recommended to identify infants who may benefit from antibiotic prophylaxis to prevent sepsis. Whether screening should be universal or targeted to high-risk groups will depend on the proportion of high-risk individuals in the screening area, the accuracy and efficiency with which infants at risk can be identified, and other characteristics of the screening program. All screening efforts must be accompanied by comprehensive counseling and treatment services. Offering screening for hemoglobinopathies to pregnant women at the first prenatal visit is recommended, especially for those at high risk. There is insufficient evidence to recommend for or against routine screening for hemoglobinopathies in high-risk adolescents and young adults, but recommendations to offer such testing may be made on other grounds (see Clinical Intervention).


Clinical Preventive Services -
Screening - Congenital Disorders -

Neural Tube Defects, Including Folic
Acid/Folate Prophylaxis

U.S. Preventive Services Task Force Recommendations:

The offering of screening for neural tube defects by maternal serum alpha-fetoprotein (MSAFP) measurement is recommended for all pregnant women who are seen for prenatal care in locations that have adequate counseling and follow-up services available (see Clinical Intervetion). Screening with MSAFP may be offered as part of multiple-marker screening (see Screening for Down Syndrome). There is insufficient evidence to recommend for or against the offering of screening for neural tube defects by mid-trimester ultrasound examination to all pregnant women, but recommendations against such screening may be made on other grounds (also see Screening Ultrasonography in Pregnancy). Daily multivitamins with folic acid to reduce the risk of neural tube defects are recommended for all women who are planning or capable of pregnancy (see Clinical Intervention).

 

Clinical Preventive Services -
Screening - Congenital Disorders -

Phenylketonuria

U.S. Preventive Services Task Force Recommendations:

Screening for phenylketonuria (PKU) by measurement of phenylalanine level on a dried-blood spot specimen is recommended for all newborns prior to discharge from the nursery. Infants who are tested before 24 hours of age should receive a repeat screening test by 2 weeks of age. There is insufficient evidence to recommend for or against routine prenatal screening for maternal PKU, but recommendations against such screening may be made on other grounds.

 

Clinical Preventive Services -
Screening - Infectious Diseases -

Asymptomatic Bacteriuria

U.S. Preventive Services Task Force Recommendations:

Screening for asymptomatic bacteriuria by urine culture is recommended for all pregnant women (see Clinical Intervention). There is insufficient evidence to recommend for or against routine screening for asymptomatic bacteriuria in diabetic or ambulatory elderly women, but recommendations against such screening may be made on other grounds. Routine screening for asymptomatic bacteriuria in other persons is not recommended.

 

Clinical Preventive Services -
Screening - Infectious Diseases -

Chlamydial Infection, Including Ocular
Prophylaxis in Newborns

U.S. Preventive Services Task Force Recommendations:

Routine screening for Chlamydia trachomatis infection is recommended for all sexually active female adolescents, high-risk pregnant women, and other asymptomatic women at high risk of infection (see Clinical Intervention). There is insufficient evidence to recommend for or against routine screening in asymptomatic men. Recommendations to screen selected high-risk male adolescents may be made on other grounds (see Clinical Intervention). Routine screening is not recommended for the general adult population. See Screening for Gonorrhea for recommendations regarding ocular prophylaxis to prevent ophthalmia neonatorum.


Clinical Preventive Services -
Screening - Infectious Diseases -

Genital Herpes Simplex

U.S. Preventive Services Task Force Recommendations:

Routine screening for genital herpes simplex virus (HSV) infection by viral culture or other tests is not recommended for asymptomatic persons, including asymptomatic pregnant women. There is insufficient evidence to recommend for or against the examination of pregnant women in labor for signs of active genital HSV lesions, although recommendations to do so may be made on other grounds (see Clinical Intervention). See Counseling to Prevent HIV Infection and other Sexually Transmitted Diseases for recommendations on counseling to prevent sexually transmitted diseases.


Clinical Preventive Services -
Screening - Infectious Diseases -

Gonorrhea, Including Ocular
Prophylaxis in Newborns

U.S. Preventive Services Task Force Recommendations:

Routine screening for Neisseria gonorrhoeae is recommended for asymptomatic women at high risk of infection (see Clinical Intervention). All high-risk women should be screened during pregnancy. There is insufficient evidence to recommend for or against screening all pregnant women or screening asymptomatic men. Recommendations to screen selected high-risk young men may be made on other grounds (see Clinical Intervention). Routine screening is not recommended for the general adult population. Ocular antibiotic prophylaxis of all newborn infants is recommended to prevent gonococcal ophthalmia neonatorum.

 

Clinical Preventive Services -
Screening - Infectious Diseases -

Hepatitis B Virus Infection

U.S. Preventive Services Task Force Recommendations:

Screening with hepatitis B surface antigen (HBsAg) to detect active (acute or chronic) hepatitis B virus (HBV) infection is recommended for all pregnant women at their first prenatal visit. The test may be repeated in the third trimester in women who are initially HbsAg negative and who are at increased risk of HBV infection during pregnancy. Routine screening for HBV infection in the general population is not recommended. Certain persons at high risk may be screened to assess eligibility for vaccination (see Clinical Intervention).

 

Clinical Preventive Services -
Screening - Infectious Diseases -

Human Immunodeficiency Virus Infection

U.S. Preventive Services Task Force Recommendations:

Clinicians should assess risk factors for human immunodeficiency virus (HIV) infection by obtaining a careful sexual history and inquiring about injection drug use in all patients. Periodic screening for infection with HIV is recommended for all persons at increased risk of infection (see Clinical Intervention). Screening is recommended for all pregnant women at risk for HIV infection, including all women who live in states, counties, or cities with an increased prevalence of HIV infection. There is insufficient evidence to recommend for or against universal screening among low-risk pregnant women in low-prevalence areas, but recommendations to counsel and offer screening to all pregnant women may be made on other grounds (see Clinical Intervention). Screening infants born to high-risk mothers is recommended if the mother's antibody status is not known. All patients should be counseled about effective means to avoid HIV infection (see Counseling to Prevent HIV and Other Sexually Transmitted Diseases).

 

Clinical Preventive Services -
Screening - Infectious Diseases -

Rubella, Including Immunization of
Adolescents and Adults

U.S. Preventive Services Task Force Recommendations:

Routine screening for rubella susceptibility by history of vaccination or by serology is recommended for all women of childbearing age at their first clinical encounter. Susceptible nonpregnant women should be offered rubella vaccination; susceptible pregnant women should be vaccinated immediately after delivery. An equally acceptable alternative for nonpregnant women of childbearing age is to offer vaccination against rubella without screening (see Clinical Intervention). There is insufficient evidence to recommend for or against screening or routine vaccination of young men in settings where large numbers of susceptible young adults of both sexes congregate, such as military bases and colleges. Routine screening or vaccination of other young men, of older men, and of postmenopausal women is not recommended.

 

Clinical Preventive Services -
Screening - Infectious Diseases -

Syphilis

U.S. Preventive Services Task Force Recommendations:

Routine serologic screening for syphilis is recommended for all pregnant women and for persons at increased risk of infection (see Clinical Intervention). See Counseling to Prevent HIV and Other Sexually Transmitted Diseases for recommendations on counseling to prevent sexually transmitted diseases.

 

Clinical Preventive Services -
Screening - Infectious Diseases -

Tuberculous Infection, Including Bacille
Calmette-Guerin Immunization

U.S. Preventive Services Task Force Recommendations:

Screening for tuberculous infection with tuberculin skin testing is recommended for asymptomatic high-risk persons. Bacille Calmette-Guérin (BCG) vaccination should be considered only for selected high-risk individuals (see Clinical Intervention).

 

Clinical Preventive Services - Screening -
Mental Disorders and Substance Abuse -

Dementia

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against routine screening for dementia with standardized instruments in asymptomatic persons. Clinicians should remain alert for possible signs of declining cognitive function in older patients and evaluate mental status in patients who have problems performing daily activities (see Clinical Intervention).

 

Clinical Preventive Services - Screening -
Mental Disorders and Substance Abuse -

Depression

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against the routine use of standardized questionnaires to screen for depression in asymptomatic primary care patients. Clinicians should maintain an especially high index of suspicion for depressive symptoms in those persons at increased risk for depression (see Clinical Intervention). Physician education in recognizing and treating affective disorders is recommended (see Screening for Suicide Risk).


Clinical Preventive Services - Screening -
Mental Disorders and Substance Abuse -

Drug Abuse

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against routine screening for drug abuse with standardized questionnaires or biologic assays. Including questions about drug use and drug-related problems when taking a history from all adolescent and adult patients may be recommended on other grounds (see Clinical Intervention). All pregnant women should be advised of the potential adverse effects of drug use on the development of the fetus. Clinicians should be alert to signs and symptoms of drug abuse in patients and refer drug abusing patients to specialized treatment facilities where available.

 

Clinical Preventive Services - Screening -
Mental Disorders and Substance Abuse -

Family Violence

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against the use of specific screening instruments to detect family violence, but recommendations to include questions about physical abuse when taking a history from adult patients may be made on other grounds (see Clinical Intervention). Clinicians should be alert to the various presentations of child abuse, spouse and partner abuse, and elder abuse.


Clinical Preventive Services - Screening -
Mental Disorders and Substance Abuse -

Problem Drinking

U.S. Preventive Services Task Force Recommendations:

Screening to detect problem drinking is recommended for all adult and adolescent patients. Screening should involve a careful history of alcohol use and/or the use of standardized screening questionnaires (see Clinical Intervention). Routine measurement of biochemical markers is not recommended in asymptomatic persons. Pregnant women should be advised to limit or cease drinking during pregnancy. Although there is insufficient evidence to prove or disprove harms from light drinking in pregnancy, recommendations that women abstain from alcohol during pregnancy may be made on other grounds (see Clinical Intervention). All persons who use alcohol should be counseled about the dangers of operating a motor vehicle or performing other potentially dangerous activities after drinking alcohol.

 

Clinical Preventive Services - Screening -
Mental Disorders and Substance Abuse -

Suicide Risk

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against routine screening by primary care clinicians to detect suicide risk in asymptomatic persons (see Clinical Intervention). Clinicians should be alert to signs of suicidal ideation in persons with established risk factors. The training of primary care clinicians in recognizing and treating affective disorders is recommended. Clinicians should be alert to signs and symptoms of depression (see Screening for Depression) and should routinely ask patients about their use of alcohol and other drugs (See Screening for Problem Drinking and Screening for Drug Abuse).

 

Clinical Preventive Services - Screening -
Metabolic, Nutritional, and Environmental Disorders -

Diabetes Mellitus

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against routine screening for diabetes mellitus in asymptomatic adults. There is also insufficient evidence to recommend for or against universal screening for gestational diabetes. Although the benefit of early detection has not been established for any group, clinicians may decide to screen selected persons at high risk of diabetes on other grounds (see Clinical Intervention). Screening with immune markers to identify persons at risk for developing insulin-dependent diabetes is not recommended in the general population.

 

Clinical Preventive Services - Screening -
Metabolic, Nutritional, and Environmental Disorders -

Elevated Lead Levels in Childhood and Pregnancy

ACPM Recommendations:

Screening for elevated lead levels via venous or capillary blood lead testing should be conducted for children aged 1 year only if they are identified as being at high risk for elevated blood lead levels. Criteria for being at high risk include: receipt of Medicaid or WIC, living in a community with ³ 12% prevalence of BLLs at ³ 10 mdg/dL, living in a community with ³ 27% of homes built before 1950, or meeting one or more high-risk criteria of a lead-screening questionnaire. This questionnaire should include both questions suggested by the CDC in their 1997 guidelines, as well as questions developed for and tailored to specific communities. These questions may pertain to use of home remedies and cosmetics, country of origin, and/or behavioral risk factors. Risk assessment for lead exposure should be performed beginning during prenatal visits and continuing until 6 years of age.

U.S. Preventive Services Task Force Recommendations:
Screening for elevated lead levels by measuring blood lead at least once at age 12 months is recommended for all children at increased risk of lead exposure. All children with identifiable risk factors should be screened, as should all children living in communities in which the prevalence of blood lead levels requiring individual intervention, including residential lead hazard control or chelation therapy, is high or is undefined (see Clinical Intervention). Evidence is currently insufficient to recommend an exact community prevalence below which targeted screening can be substituted for universal screening. Clinicians can seek guidance from their local or state health department. There is insufficient evidence to recommend for or against routine screening for lead exposure in asymptomatic pregnant women, but recommendations against such screening may be made on other grounds. There is also insufficient evidence to recommend for or against counseling families about the primary prevention of lead exposure, but recommendations may be made on other grounds. Recommendations regarding the primary prevention of lead poisoning by population-wide environmental interventions are beyond the scope of this chapter.

 

Clinical Preventive Services - Screening -
Metabolic, Nutritional, and Environmental Disorders -

Iron Deficiency Anemia, Including Iron Prophylaxis

U.S. Preventive Services Task Force Recommendations:

Screening for iron deficiency anemia using hemoglobin or hematocrit is recommended for pregnant women and for high-risk infants. There is insufficient evidence to recommend for or against routine screening for iron deficiency anemia in other asymptomatic persons, but recommendations against screening may be made on other grounds (see Clinical Intervention). Encouraging parents to breastfeed their infants and to include iron-enriched foods in the diet of infants and young children is recommended (see also Counseling to Promote a Healthy Diet). There is currently insufficient evidence to recommend for or against the routine use of iron supplements for healthy infants or pregnant women.

Clinical Preventive Services - Screening -
Metabolic, Nutritional, and Environmental Disorders -

Obesity

U.S. Preventive Services Task Force Recommendations:

Periodic height and weight measurements are recommended for all patients (see Clinical Intervention).

 

Clinical Preventive Services - Screening -
Metabolic, Nutritional, and Environmental Disorders -

Thyroid Disease

U.S. Preventive Services Task Force Recommendations:

Routine screening for thyroid disease with thyroid function tests is not recommended for asymptomatic children or adults. There is insufficient evidence to recommend for or against screening for thyroid disease with thyroid function tests in high-risk patients, but recommendations may be made on other grounds (see Clinical Intervention). Clinicians should remain alert to subtle symptoms and signs of thyroid dysfunction when examining such patients. See also Screening for Congenital Hypothyroidism.

Clinical Preventive Services - Screening -
Musculoskeletal Disorders -

Adolescent Idiopathic Scoliosis

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against routine screening of asymptomatic adolescents for idiopathic scoliosis. Clinicians should remain alert for large spinal curvatures when examining adolescents.

 

Clinical Preventive Services - Screening -
Musculoskeletal Disorders -

Postmenopausal Osteoporosis

U.S. Preventive Services Task Force Recommendations:

There is insufficient evidence to recommend for or against routine screening for osteoporosis with bone densitometry in postmenopausal women. Recommendations against routine screening may be made on other grounds (see Clinical Intervention). All postmenopausal women should be counseled about hormone prophylaxis (see Immunizations/Chemoprophylaxis for Postmenopausal Chemoprophylaxis) and be advised of the importance of smoking cessation, regular exercise, and adequate calcium intake (see Counseling to Prevent Tobacco Use, Counseling to Promote Physical Activity, and Counseling to Promote a Healthy Diet). For those high-risk women who would consider estrogen prophylaxis only to prevent osteoporosis, screening may be appropriate to assist treatment decisions (see Clinical Intervention).

 

Clinical Preventive Services -
Screening - Neoplastic Diseases -

Bladder Cancer

U.S. Preventive Services Task Force Recommendations:

Routine screening for bladder cancer with urine dipstick, microscopic urinalysis, or urine cytology is not recommended in asymptomatic persons. All patients who smoke tobacco should be routinely counseled to quit smoking (see Counseling to Prevent Tobacco Use).