Physicians in the Pacific Northwest Evidence-based Practice Center at OHSU in Portland, Oregon, played a critical role in updating recommendations for the Women’s Preventive Services Guidelines. The updates, drafted by the Women’s Preventive Services Initiative, a national coalition convened by the American College of Obstetricians and Gynecologists, were adopted the by U.S. Department of Health & Human Services Health Resources & Services Administration for coverage under the Affordable Care Act.
The updated recommendations address unique health issues women face, covering topics from screening pregnant women for gestational diabetes to providing education and risk assessment for HIV in adolescent and adult women.
Heidi D. Nelson, M.D., M.P.H., research professor of medicine, and medical informatics and clinical epidemiology in the OHSU School of Medicine, served as principal investigator for the evidence reviews, funded by HRSA. She was a member of the Institute of Medicine (now the National Academies of Science, Engineering and Medicine) panel that convened in 2011 to develop the initial recommendations. She and co-investigators in the Pacific Northwest EPC, including co-investigators Amy Cantor M.D., M.P.H., and Bernadette Zakher M.B.B.S., evaluated current research on the effectiveness of nine prevention services. These evaluations served as the basis for the evidence-based recommendations.
"Good medicine is based on good science, especially when it comes to preventive services. We don’t want to recommend services to millions of healthy women unless we know they are scientifically proven to prevent illness or disease,” says Nelson. “What’s important about these updated recommendations is the services are more clearly defined, and we were able to put a finer point on how providers can standardize implementation of the services and how women can access them. We were also able to dive deeper into the available science which has only gotten stronger over the past 5 years."
The recommended screening services, now covered at no cost under the Affordable Care Act for an estimated 57 million women, include:
- Breast cancer screening for average-risk women aged 50 to 74 every two years, but beginning as early as age 40 and continuing through older age groups and provided annually depending on individual considerations.
- Comprehensive lactation support services and supplies during pregnancy and the postpartum period to encourage successful breastfeeding.
- Cervical cancer screening for average-risk women aged 21 to 65, including screening for women ages 21 to 29 using a Pap test every three years, and Pap test with human papillomavirus testing for women aged 30 to 65 every five years.
- Screening for gestational diabetes mellitus in pregnant women after 24 weeks of gestation with earlier screening for women at risk for diabetes.
- Contraceptive care for adolescent and adult women with access to the full range of FDA-approved female-controlled contraceptive services.
- Prevention education and risk assessment for HIV Infection in adolescents and adult women at least annually throughout the lifespan, and receiving at least one HIV test for all women during their lifetimes and during pregnancy.
- Screening adolescents and women for interpersonal and domestic violence and, when needed, providing or referring for intervention services.
- Directed behavioral counseling for sexually active adolescent and adult women at increased risk for sexually transmitted infections.
- Preventive care visits at least one visit per year, beginning in adolescence and continuing across the lifespan to ensure that the recommended preventive services are obtained.
“I am happy to see this ground-breaking work come to fruition with OHSU playing a key role,” says Michelle Berlin, M.D., M.P.H., co-director of the OHSU Center for Women’s Health; professor of obstetrics and gynecology, OHSU School of Medicine; and professor of public health and preventive medicine, OHSU-PSU School of Public Health. “These recommendations for women’s health care cover the spectrum of preventive services to ensure a holistic approach to women’s health. They also reinforce the importance of women having a primary care provider who understands the unique health care needs of women and tailors their care.”
The Pacific Northwest EPC, founded in 1997, is a collaboration of OHSU, the University of Washington CHASE Alliance in Seattle, Washington, and Spectrum Research, Inc. in Tacoma, Washington, that conducts systematic reviews on a variety of health care topics for federal and state agencies, professional associations and foundations. The Pacific Northwest EPC reports the evidence from clinical research studies and the quality of that evidence for use by clinicians, employers, policymakers, researchers and others in making decisions about the provision of health care services and health research. The Pacific Northwest EPC is funded in part by the Agency for Healthcare Research and Quality and directed by Roger Chou, M.D., a professor of medicine (general internal medicine and geriatrics), and medical informatics and clinical epidemiology in the OHSU School of Medicine.