USPSTF CLINICAL GUIDELINES IN A PHYSICIAN ASSISTANT CURRICULUM Timothy Quigley, MPH, PA-C Associate Professor Wichita State University

Physician Assistants  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 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

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

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.

USPSTF and AAPA  Long AAPA clinical partnership with USPSTF  Also 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

Wichita State University 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.

WSU PA Graduate Practice Settings, (%) Source: AAPA, 2007; n=1117

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 website  Competency  Working familiarity with Recommendations in Guide  Personal Digital Assistants (PDAs)  Required for clinical rotations  Linked to Electronic Preventive Services Selector through USPSTF

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 website and guide

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)