The Prevention TaskForce (formerly ePSS) is an application designed and developed by the U.S. Department of Health & Human Services (HHS), Agency for Healthcare Research and Quality (AHRQ), the Nation’s lead Federal agency for research on healthcare quality, costs, outcomes, and patient safety. It was developed by AHRQ to support the independent U.S. Preventive Services Task Force (USPSTF). The USPSTF is an independent government organization of 16 experts in prevention from across the U.S. who collaborate on health promotion recommendations using strict EBM principles. They cover every aspect of preventive care from pediatrics to geriatrics to women’s health to behavioral health. Each recommendation is based upon the best available evidence, risks/benefits, and provided an evidence letter grade.
We previously favorably reviewed the Agency for Healthcare Research and Quality (AHRQ) app called ePSS (electronic preventive services selector). The app includes all of the current recommendations from the United States Preventive Services Task Force (USPSTF). The recommendations from the USPSTF are routinely used by primary care providers and covered by Medicare. At times, their recommendations, such as those on prostate cancer (recently revised) screening and breast cancer screening, have caused significant controversy. Overall, their strict adherence to the best available medical evidence is admirable. This new version keeps the same functionality of the old app, but looks and works even better.
Clinical Scenario:
A 60 year-old sexually active female smoker with a past medical history of type 2 diabetes, hypertension and hyperlipidemia presents for her annual exam. The patient’s most recent A1c is 7.0, most recent LDL-C is 70 on a moderate intensity statin. According to your nurse she likely needs some cancer screening tests. The patient asks if she needs a mammogram (she had one last year) or a pap smear (she had one 6 years ago). She weighs 165 lbs and is 5’3”. What preventive services do you offer her?
How to use the Prevention TaskForce app to determine care for this patient:
Using the Prevention TaskForce app, we can quickly determine which preventive services this patient needs. By inputting her age, ht/wt, gender, sexual activity and tobacco hx, we can quickly calculate lists of items that we should ensure this patient receives based on the best available evidence. The app divides the lists into letter categories–A/B (now together at last!), C, D, and I–based on the quality of the evidence. Typically, anything in the A or B categories should be recommended as it has the highest supporting evidence. Items in the “D” category (such as carotid artery stenosis screening in our particular case) are not recommended as the risks of harm outweigh the benefits. Items in the “I” category are uncertain as there is currently “insufficient evidence for or against” the recommendation (such as bladder cancer screening in our patient’s case).
For our patient, the category “A/B” items we can discuss with our patient include cervical cancer screening, colorectal cancer screening, and tobacco cessation, alcohol misuse breast cancer (screening and preventive medications, BRCA screening), lung cancer, Hep B/C, in addition to the “obvious” screening for hypertension. Our patient is due to cervical cancer screening since her last pap was 6 years ago, but according to our electronic medical record, she is up to date on her colon cancer screening. We counsel the patient at length on tobacco cessation and she agrees to attend our clinic tobacco cessation program and likely start a medication such as nicotine replacement therapy. The patient is already on a statin, but the app also includes that recommendation. The patient has no family history of breast cancer so we don’t offer her BRCA screening and since her last mammogram was last year, we can use the app’s “clinical rationale” section to help explain to the patient why she doesn’t need a mammogram for another year. The USPSTF continues to get pushback from some groups regarding its breast cancer screening recommendations, especially in patients under 50. Interestingly, the group was aggressive in adopting LDCT for lung cancer screening. After discussing the risks/benefits with the patient, she decides not to undergo the LDCT test.
Interestingly, the app places aspirin use in category “C” for our patient. For aspirin use, I recommend providers use the outstanding Aspirin Guide app since the recommendations for aspirin use in the ePSS app are challenging to understand since it requires the use of multiple risk calculators (not included in the app). Recent evidence continues to cast doubt on the use of aspirin for the prevention of CVD and CRC.
There are some items in the “D” category worth mentioning to our patient–especially since many women may ask about them or are currently using them. For example, the USPSTF recommends against the use of hormone therapy in postmenopausal women for the prevention of chronic conditions and recommends against the use of vitamin D and calcium to prevent fractures in noninstitutionalized women. Many patients’ jaws drop when reviewing category “D” items, so make sure to show them this section too.
Finally, it is sometimes worth mentioning the “I” category items, as some patients may be curious about these recommendations. For our patient, perhaps mentioning the “I” recommendation for the pelvic exam (do the pap, just not the pelvic) and/or the electronic nicotine delivery recommendation (use proven cessation methods, not the e-cigarette).
In the end, our patient agrees to have her pap smear completed, accepts a referral for tobacco cessation counseling/medications, gets HIV/hepatitis B/C screening, continues her statin, waits a year for her mammogram and declines lung cancer screening. By using this app with nearly EVERY patient (especially those for “annual exams”), you can ensure your patients receive the recommended preventive services and improve your provider-patient relationship by showing patients “why” you do/don’t do certain medical treatments based on the best available evidence.
Evidence-Based medicine
This new version of ePSS, now called Prevention TaskForce, incorporates all of the latest AHRQ recommendations and tools in one fabulous point-of-care app. The AHRQ utilizes the most rigorous EBM evaluations with exhaustive systematic reviews for each topic. The app includes each evidence summary and links to the full recommendation. The app easily sorts each group of recommendations by the letter grade and within each recommendation, you can browse the overview, rationales, clinical considerations, and any relevant tools for that topic.
What providers would benefit from this app?
Students, residents, mid-levels, primary care, and specialist providers from almost any medical field and any provider who provides preventive services to patients.
Price
o Free.
Likes
o New design is easy, intuitive, and more functional than the old ePSS (new BMI filter)
o Ability to share, print, save searches, bookmark
o Available for Android
Dislikes
o Tools section still in need of a redesign, old layout, poorly organized
o Improved definition of Grade Levels, but still likely not detailed enough
o Clinical summaries and some other tables difficult to read
Overall
The newly refreshed ePSS app, now called Prevention TaskForce, is fantastic. The app has never looked or worked better. Although still not perfect (please update and organize the Tools section!), the facelift is more than skin deep with some truly handy updates (love the grouping of A/B recs together). The overall information and “instructions” have been updated and expanded and new information (height and weight) have been added to the search section. Prevention Taskforce is now more than ever a must-have app for primary care and most any other provider.
Overall Score
o 5.0
User Interface
o 5.0
Much improved interface with great use of color, better organization, and search function.
Multimedia Usage
o 4.5 stars
The app contains many working hyperlinks to USPSTF website and other organizations. Most information is available on the app. Tool section could be improved with a more organized layout and expanded offerings.
Price
o 5 stars
App is free.
Real-World Applicability
o 5.0 stars
An app that no one in primary care should leave home without, Prevention Taskforce brings the USPSTF recommendations to life. Great for virtually any patient care visit, the app begs to be used at the point of care and makes for fantastic shared decision-making with patients. This latest version just makes the entire process that much easier and enjoyable.
Device Used For Review
o iPhone 11 Pro running iOS 13.5.
Available for Download for iPhone, iPad, and Android.
