Foreword

Thomas R. Frieden, MD, MPH

Director, CDC

Corresponding author: Thomas R. Frieden, Director, CDC, 1600 Clifton Road, NE, MS D-14, Atlanta, GA 30333. Telephone: 404-639-7000; E-mail: TFrieden@cdc.gov.

CDC has a long history of monitoring the use of clinical preventive services to provide public health agencies, health care providers and their partners information needed to plan and implement programs that increase use of these services and improve the health of the U.S. population. Better use of clinical preventive services could prevent tens of thousands of deaths each year. With passage of the Patient Protection and Affordable Care Act of 2010 as amended by the Heathcare and Education Reconciliation Act of 2010, which expands health insurance coverage for the United States population and increases access to preventive services, there are new opportunities to promote and improve use of these valuable and life-saving services. This report provides baseline data prior to implementation of the provisions of the Affordable Care Act.

Public health and clinical medicine complement and enrich each other, but they must engage with each other to maximize their impact. Synergies created through cooperation can amplify the impact that either might produce working alone. Public health can also serve as an honest broker by providing unbiased and scientifically accurate information to policy makers, the health-care community, and the public, and is well equipped to monitor health systems to facilitate increases in effectiveness and efficiency.

This MMWR Supplement on the Use of Selected Clinical Preventive Services Among Adults — United States, 2007–2010 is the first in a periodic series of reports examining use of selected clinical preventive services. There are other important preventive health services, such as screening and brief intervention for problem alcohol use and screening and effective treatment of depression, but robust national data for these services are not currently available. For other important health problems, there are no proven, recommended clinical preventive services at present. The report focuses on the following adult services:

• Use of aspirin or antiplatelet therapy to prevent recurrent cardiovascular disease events among adults with a history of ischemic vascular disease and use of aspirin in the general population among those at increased risk for cardiovascular disease,
• control of blood pressure among adults with hypertension,
• screening for lipid disorders,
• control of blood glucose among adults who have had diabetes diagnosed,
• screening for tobacco use in office-based ambulatory-care settings and tobacco cessation counseling and medication use among current tobacco users,
• screening using mammography for breast cancer among women,
• screening for colorectal cancer in the adult population,
• assuring awareness of human immunodeficiency virus-status among those who are infected, and
• vaccination against influenza in adults.

The findings of this report indicate that tens of millions of people in the United States have not been benefitting from key preventive clinical services, and that there are large disparities by demographics, geography, and health care coverage and access in the provision of these services.

• Slightly less than half of patients with diagnosed ischemic cardiovascular disease were prescribed aspirin or other antiplatelet agents.
• Despite improvements in hypertension treatment and control over the past10 years, slightly less than half of persons in the United States with high blood pressure had it under control, and levels of control were particularly low for people who are uninsured or do not have a usual source of heath care.
• Only two thirds of adults (68%) had their cholesterol levels checked during the preceding 5 years, and among persons with high LDL cholesterol levels, less than one third (31.6%) had it under control. More than one third (36%) of people in the United States had elevated levels of low-density lipoprotein cholesterol.
• More than one third (37.3%) of outpatient visits had no documentation of tobacco use status; just one in five (20.9%) who screened positive for tobacco use received tobacco cessation counseling, and less than one in 13 (7.6%) tobacco users were prescribed cessation medications. Rates of counseling were particularly low among younger smokers, despite a high level of interest in quitting in this population; younger smokers have been shown to be more likely to try to quit but less likely to succeed, hence could benefit particularly from improved counseling and treatment
• Approximately 2.3 million adults (12.9%) with diagnosed diabetes had poor glycemic control (A1c > 9.0).
• Approximately one in five women age 50–74 years had not had a mammogram during the preceding 2 years.
• Although there have been large increases in recent years, still approximately one third of adults aged 50–75 years were not up-to-date with screening for colorectal cancer, which is the second leading cause of cancer death in the United States, the leading cause of cancer death among nonsmokers, and which can be prevented through screening and follow-up.
• Approximately one in five of the 1.1 million persons in the United States living with HIV had not been diagnosed.
• Only approximately one in four (28%) of adults aged <65 years were vaccinated against influenza; 133 million adults were not vaccinated, and vaccination rates were particularly low among the poor and those without health insurance or a medical home.

Improved clinical management of the ABCS — aspirin, blood pressure control, cholesterol management, and smoking cessation — can significantly reduce the risk for cardiovascular disease, our nation's leading killer, and could save approximately 100,000 lives each year. The Million Hearts initiative, which targets improvements in both clinical preventive practice (e.g., ABCS) and community prevention (e.g., reducing smoking and exposure to secondhand smoke and decreasing sodium and artificial trans-fat intake) by engaging public and private sectors, can prevent a million heart attacks and strokes over the next 5 years. This can reduce the number of people who need treatment and the costs of health care to our society.

This report documents the potential benefits of selected clinical preventive services, the problem of their underuse, and effective collaborative strategies to improve use. I hope the report will help increase use of these services and thereby help people in the United States live longer, healthier, and more productive lives.