University of North Texas Uses Task Force Guide to Clinical Preventive Services in Student Research
An education and training program for physician assistants at the University of North Texas Health Science Center in Fort Worth is using the U.S. Preventive Services Task Force's Guide to Clinical Preventive Services. The Guide, a convenient compilation of abridged Task Force recommendations, is being put to use as a tool for student research on clinical preventive services.
The students are studying the provision and documentation of preventive services in the primary care practices where they receive their training. The program's former Vice Chair of Clinical Services, Patti Pagels, PA-C, MPAS, hopes that these investigations will help students foresee the complex issues they will face in their future practices. "As they work to provide the right screening, counseling, and other preventive health care services to their patients, this training will be invaluable," Pagels notes.
The University of North Texas Health Science Center program is a three-year master's program. About 110 students are in the program at any one time, divided into three yearly cohorts. They receive about 20 months of classroom experience and 12-13 months of rotations in primary care settings. All students are required to take a course in health promotion and disease prevention. In addition, they have the option of doing a directed research project in preventive services.
Pagels found the 2006 edition of the Guide to Clinical Preventive Services one day in her mailbox, and was impressed by the efficient way it summarizes and explains the recommendations of the U.S. Preventive Services Task Force. She decided that it would be a useful teaching tool.
She explains, "I decided to use the Guide to jump-start research projects on preventive services. I wanted to show the students the broad range of recommendations that are available, and encourage them to zero in on topics of particular interest to them."
Once students familiarized themselves with the Guide and selected their topics, Pagels worked with them to design their research projects. Students paired up and began their projects by gathering additional information about their chosen topics from the AHRQ Web site and from guidelines issued by professional societies and other groups.
Then they searched systematically through volumes of medical charts looking for documentation that the particular preventive service of interest had been provided. They used a structured survey to gather demographic information on each patient, information about the guidelines that were followed, and an estimate of how well the health care provider had followed the guidelines.
One pair of students looked for evidence that men had been screened for osteoporosis, and found that, by and large, this had not happened. Others focused on the provision of various screening services to the over-65 age group. They found that many services pap smears, for example, continued to be provided even though they were no longer recommended. Other students looked at screenings for obesity in children. They reported that a key factor determining whether screening was done was the existence of a reminder system to prompt the clinician to provide the service.
Pagels used this research experience to drive home to students the point that Task Force recommendations and other professional guidelines represent a standard of care to which clinicians may be held accountable. She says, "I warned them that they will not be able to plead ignorance, because these recommendations are now so easily available. If they decide not to provide a particular service perhaps because the patient has declined to receive it—or because the service is not recommended—they need to document in the medical record the reasons for their decision."
On the other hand, the students came to realize that not every preventive service can be provided, because there is simply not enough time in a busy clinic or physician's office to do all the screenings or counseling that could be done. Pagels encouraged them to think about how priorities should be set so that the most cost-effective services are provided and the clearly ineffective services eliminated.
Pagels believes that her students' research experiences and their detailed study of the recommendations have given them a picture of the thoughtful, deliberative process that goes into the development of preventive services recommendations. "They saw that the recommendations of the Task Force are based on extensive research and on discussions among several independent professionals," she said. "Their coursework alone could not give them this perspective."
According to Pagels, the physician assistant program at the University of North Texas Health Science Center is expanding rapidly, and may double in size in the next five years. The research option will be retained as a required master's project.
The Guide to Clinical Preventive Services 2008: Recommendations of the U.S. Preventive Services Task Force. AHRQ Pub. No. 08-05122. Rockville, Maryland: Agency for Healthcare Research and Quality, September 2008.