PRACTICE GUIDELINES COMMITTEE

November 2000

Neal Kohatsu, M.D., M.P.H., Chair                                       Jessica Cafarella, Staff

Published Policies

• Counseling on Hormone Replacement for Peri and Postmenopausal Women, David Katz, MD and Haq Nawaz, MD, Griffin Hospital, Connecticut. Am J Prev Med. October 1999.

• Tobacco Cessation Counseling. Jane Kattapong, MD, University of Washington Preventive Medicine Residency Program. Am J Prev Med. August 1998.

• Screening for Prostate Cancer in American Men. Rebecca L. Ferrini, MD, MPH, University of California/California State University and Steven H. Woolf, MD, FACPM, Medical College of Virginia. Am J Prev Med. July 1998.

• Adult Immunizations. Ann R. Fingar, MD, MPH and Byron J. Francis, MD, FACPM, Illinois Department of Public Health. Am J Prev Med. February 1998.

• Screening for Skin Cancer. Rebecca L. Ferrini, MD, MPH, Monica Perlman, MD, MPH and Linda Hill, MD, FACPM, University of California/California State University General Preventive Medicine Residency Program. Am J Prev Med. January 1998.

• Physician Recommendation of Protection from UV Light Exposure. Rebecca L. Ferrini, MD, MPH, Monica Perlman, MD, MPH and Linda Hill, MD, FACPM, University of California/California State University General Preventive Medicine Residency Program. Am J Prev Med. January 1998.

• Screening Asymptomatic Women for Ovarian Cancer. Rebecca L. Ferrini, MD, MPH, University of California/California State University General Preventive Medicine Residency Program. Am J Prev Med. November/December 1997.

• Childhood Immunizations. Linda Kinsinger, MD, FACPM and Rita Patel, MD, University of North Carolina Preventive Medicine Residency Program. Am J Prev Med. March/April 1997.

• Cervical Cancer Screening. William M. Marine, MD, FACPM and residents at the University of Colorado Health Service Center. Am J Prev Med. September/October 1996.

• Screening Mammography for Asymptomatic Women. Rebecca L. Ferrini, MD, Elizabeth Mannin, MD, Edith Ramsdell, MD and Linda Hill, MD, FACPM. University of California/California State University General Preventive Medicine Residency Program. Am J Prev Med. September/October 1996.

Scheduled for Publication

• Screening for Elevated Blood Lead Levels in Children. Wendy G. Lane, MD, University of Maryland. (January 2001)

• Counseling on Physical Activity. Kevin Patrick, MD, FACPM and residents at San Diego State University.

• Hepatitis A Vaccination. Linda Kinsinger, MD, MPH and Chesley Richards, MD, MPH, University of North Carolina at Chapel Hill.

• Guideline for Vitamin E Use in Patients with Risk of Cardiovascular Disease. Gary Caplan, MD, MPH, University of Kentucky.

• Physician Recommendation for Weight Loss. Haq Nawaz, MD, MPH and David Katz, MD, MPH, Griffin Hospital, Connecticut.

• Screening for Chlamydia Trachomatis. Katerina Hollblad-Fadiman, MD, MPH, Santa Clara County Public Health Department, San Jose, California.

• Screening for H.pylori in High Risks Groups. Bonnie Henry, MD, Tonya Gosha, MD and Linda Hill, MD, FACPM, San Diego State University.

• Screening for Hemochromatosis. Linda Hill, MD, FACPM and residents at San Diego State University.

• Screening for Hepatitis C. Bonnie Henry, MD and Linda Hill, MD, FACPM, San Diego State University.

• Counseling Children and Adolescents for Osteoporosis Prevention. Regina Fleming, MD, MSPH, Sandra Almeida, MD, MPH, and Kevin Patrick, MD, MS at San Diego State University.

• Screening for Testicular Cancer. Rebecca L. Ferrini, MD, MPH, University of California/California State University.

• Varicella Vaccination. Josette Roukhalil, MD, MPH, Griffin Hospital, Connecticut.

• Vitamin A Supplementation. Haq Nawaz, MD, MPH and David Katz, MD, MPH, Griffin Hospital, Connecticut.

• Needle Exchange Programs to Reduce Drug-Associated Morbidity and Mortality. Rebecca Ferrini, MD, MPH, University of California/California State University. Am J Prev Med. February 2000.

• Folic Acid Fortification of Grain Products in the U.S. to Prevent Neural Tube Defects. Jennifer Bentley, MD, MPH, Rebecca Ferrini, MD, MPH, and Linda Hill, MD, MPH., San Diego, California. Am J Prev Med. April 1999.

• Strengthening Motor Vehicle Occupant Protection Laws. Rebecca Ferrini, MD, MPH. University of California/California State Univ. Am J Prev Med. September/October 1997.

• Breastfeeding. Miriam Labbok, MD, MPH, Georgetown University, Washington, DC.

• Handgun Control. Christopher R. Armstrong, MD, MPH, Naval Branch Medical Clinic, Jacksonville, North Carolina.

• Newborn Hearing Screening. Thomas Clark, MD and Jay Kravitz, MD, MPH, Oregon Health Sciences University, Portland, Oregon.

• Violence Prevention. Haq Nawaz, MD, MPH and David Katz, MD, MPH, Griffin Hospital, Connecticut.

• The Availability of Emergency Contraception as an Over-the-Counter Medication. Julie Howe, MD and Linda Hill, MD, MPH, University of North Carolina.

• PPD Screening in School Children. Soju Chang, MD, MPH and Miriam Alexander, MD, MPH, John Hopkins University.

• Screening for Domestic Violence. Arlene Seid, MD and Linda Hill, MD, MPH, San Diego State University.

At PREVENTION 2000, the ACPM Board of Regents adopted the Practice Guidelines (PG) Committee’s recommendation to: 1) expand the scope of the PG Committee to include quality improvement and implementation activities; and 2) change the name of the committee to reflect its expanded scope. Following PREVENTION, PG Committee members used the listserv to discuss topics that may fall under the scope of the expanded committee. Members suggested expanding the role of the committee to include:

Implementation of Delivery of Care
Outcomes of Delivery of Care
Patient Safety
Patient Care Quality Improvement
Public Health Quality Improvement
Preventive Practices Quality Improvement

PG Committee members agreed to revise the committee’s charge to reflect the expanded scope of the committee, and to use the revised charge to generate a new name for the committee that accurately reflects its mission. A significant portion of the PG Committee meeting on November 12, 2000 will be dedicated to these activities.

Through discussion on the ACPM PG Committee listserv, committee members decided to update ACPM practice policy and public policy statements at least once every three years (as opposed to once a year, as originally proposed).

ACPM has begun the revision process with its two existing guidelines on immunization: "Adult Immunizations" and "Childhood Immunizations." The authors of the original guidelines are working to update the ACPM guidelines, and the revised guidelines will be published in the American Journal of Preventive Medicine.

In recent months, ACPM has begun development of patient education articles on preventive medicine topics through a partnership with Medem, Inc. (www.medem.com). Medem is an Internet-based company that provides physicians with customized Web sites to renew and empower their relationships with patients both on and offline. Each physician Web site created by Medem includes guidelines from medical societies on topics within the physician’s specific area of practice, as well as less technical patient education articles for use by both the physician and patient. Medem already has posted ACPM’s existing practice policy and public policy statements on its Web site, and will continue to work with ACPM to develop patient education articles. Currently, ACPM and Medem are working together to develop their first patient education article, which will address prostate cancer.

ACPM staff have created a summary document to inform residents, residency directors, and other potential authors of the process involved in the development of ACPM policy statements. The document discusses: 1) procedure for topic selection; 2) topic selection criteria; 3) the path policies follow; 4) format requirements; 5) suggested topics for guideline development; and 6) how to get involved in ACPM guideline development.

• The committee implemented a procedure whereby authors have six months to submit an initial draft of a guideline following assignment of a topic and whereby drafts provide specific author names in their proposals, not just the name of a program.
• ACPM staff have developed a spreadsheet to track the development of all policies.
• The committee has decided to offer, but not require, the use of a content expert to each author when they begin guideline development. Content experts still will review each guideline prior to submission to the American Journal of Preventive Medicine.
• The committee has been active in reviewing the guidelines currently being developed by the U.S. Preventive Services Task Force.

• Defining an "active" committee member; updating the committee membership list
• Revision of committee summary document

• Status of existing practice and public policies
• New policy requests
• Revision of suggested topics for policy development

• ACPM/Medem collaboration
• Current guideline development

• Areas/topics covered by the expanded committee
• Redefining the committee charge
• Changing the name of the committee