IOM report recommends 8 preventive women's health services

A new report from the Institute of Medicine (IOM) recommends that 8 preventive health services for women be added to the services that health plans will cover at no cost to patients under the Patient Protection and Affordable Care Act of 2010 (PPACA).

The PPACA requires plans to cover the services listed in the comprehensive list of preventive services published by the U.S. Department of Health and Human Services (HHS). At the agency's request, an IOM committee identified critical gaps in preventive services for women, along with measures that will further ensure women's health and well-being.

The recommendations are based on a review of existing guidelines and an assessment of evidence for the effectiveness of different preventive services. The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions. The report suggests the following additional services:

• Screening for gestational diabetes
• Human papillomavirus (HPV) testing, as part of cervical cancer screening for women over age 30
• Counseling on sexually transmitted infections
• Counseling and screening for HIV
• Contraceptive methods and counseling to prevent unintended pregnancies
• Lactation counseling and equipment to promote breast-feeding
• Screening and counseling to detect and prevent interpersonal and domestic violence
• Yearly well-woman preventive care visits for recommended preventive services

“These latest recommendations from the IOM should be welcomed and applauded by our healthcare industry, given the well-recognized outcomes that may be derived from greater access to such services,” said David Calabrese, RPh, MHP, chief clinical officer, Med Metrics Health Partners, Worcester, Mass.

For example, the health and financial impact of intimate partner violence (IPV) is vast and widespread, indicating that any plan designed to strengthen screening and intervention efforts is a welcome addition, said Jeff R. Temple, PhD, an assistant professor and psychologist in the department of obstetrics and gynecology at University of Texas Medical Department (UTMB Health), Galveston, Texas.

Indeed, a report by the Centers for Disease Control and Prevention estimated that IPV results in more than $4 billion a year in healthcare services. “However, given recent research showing that screening for IPV may not, in and of itself, result in improved violence outcomes, a concomitant investment should also be made in enhancing the quality, availability, and utilization of services offered to abused women,” Temple told Drug Topics.

“A concerted effort should be made to prevent potential early predictors of intimate partner violence, such as bullying and teen dating violence. While initially costly, attending to these abusive behaviors in our youth would not only result in healthier adult relationships, but would have the potential to save a substantial amount of healthcare dollars in the long run,” he said.

“Further, we should not overlook the role of perpetrators. Efforts to screen and offer evidenced-based interventions to men and women who commit acts of partner violence should be strengthened.”

“From a pharmacy perspective, our nation's pharmacists are once again in an ideal position to assist in reinforcing these efforts, as many are focused in areas of women's health that are familiar to our profession,” Calabrese added. “We also have the greatest degree of direct interaction with the patient community, thus providing yet another opportunity for us to demonstrate our value in further driving a higher-quality, more cost-efficient healthcare system for all."

The HHS guidelines on preventive health services for women will need to be updated routinely in light of new science. As part of this process, the report said, HHS should establish a commission to recommend which services health plans should cover. The commission should be separate from the groups that assess evidence of health services' effectiveness, and it should consider cost-effectiveness analyses, evidence reviews, and other information to make coverage recommendations.

The report addresses concerns that the current guidelines on preventive services contain gaps when it comes to women's needs. Women suffer disproportionate rates of chronic disease and disability from some conditions. Because they need to use more preventive care than men on average, owing to reproductive and gender-specific conditions, they face higher out-of-pocket costs, the report noted.