Prevention/Risk Reduction - GENERAL CME OVERVIEW

Please scroll down through the general topic overview and the CME activity-specific overview and then click on "I accept". Once you have registered/logged in and accepted this overview, you will see only the specific CME activity overview the next time you select any Prevention/Risk Reduction CME-certified activity

Chronic diseases cause 70% of deaths each year. Yet the onset of most chronic conditions can be delayed or limited in progression with behavioral interventions, such as avoiding risky behaviors, increasing physical activity, and obtaining life-saving screening services [1]. Under new provisions in the Affordable Care Act, an estimated 31 million individuals enrolled in new employer plans and 10 million in new individual plans are expected to benefit from fully covered preventive services sometime in 2011[2].

While the changes to Medicare coverage for preventive services will present challenges to providers, the expansion of coverage is a great opportunity for patients and clinicians to receive and offer, respectively, better preventive care [3,4]. Medicare is now completely covering an annual wellness visit, in addition to a number of screening tests and counseling activities. Reimbursement for these activities is set for a few, but for the most part are determined by intermediaries. The following gaps in knowledge and practice have been identified, through needs assessment research, to exist among clinicians and medical staff, and are covered in the CME activities that follow:
•    Gaps in Screening and preventive care exist for HIV, osteoporosis, cancer, alcohol addiction and depression

•    Gaps in risk reduction exist for Cardiovascular Health

•    Uneven application of pediatric and adult immunization guidelines

•    Gaps in knowledge and application of  information regarding office systems to improve preventive efforts

1.    Clarke JL. Preventive medicine: a ready solution for a health care system in crisis. Popul Health Manag. 2010; 13 Suppl2: S3.
2.    Background: The Affordable Care Act’s New Rules on Preventive Care. web site. July 14, 2010.  
3.    Terry K. Trendspotter: Preventive Services in Reform Law Benefits Doctors and Patients. Physicians Practice web site. September 1, 2010.
4.    Hughes C. What you need to know about the Medicare preventive services expansion.  Family Practice Management 2011;18: 22-25

TARGET AUDIENCE: Physicians in primary care practice, physician assistants, nurse practitioners, and other health care providers and clinical practice teams.

EDUCATIONAL GOALS & OBJECTIVES: After participating in this educational initiative, learners are generally expected to:

  • Improve identification of risk factors for HIV infection, Cardiovascular Disease, and alcohol dependence
  • Improve implementation of screening and testing guidelines for HIV, osteoporosis, alcohol addiction, depression, and cancer
  • Improve their ability to counsel patients in smoking cessation and reduction of alcohol abuse
  • Design and prescribe individualized lifestyle modification programs to reduce patient risk for chronic disease, including cardiovascular disease
  • Improve rates of immunization for children, adolescents and adults
  • Integrate pharmacotherapy, when needed, to reduce risk of chronic disease progression
  • Integrate technologies and efficient officesystems to assist with disease prevention and risk reduction efforts

Media Use: This educational initiative was developed as a web-based multimedia self-study educational and resource curriculum using the following formats:

  • Interactive minicase studies
  • Simulations
  • Targeted search at the point of care using the iSEEK search engine
  • Internet-based enduring materials
  • Evidence-based resources
  • References to physician staff and patient education links


  • Clinical reviews in HTN present critical areas of knowledge in the disease organized in a coherent pathway, along with practical approaches to achieving best practices. This section provides a foundation and reference base for other featured interventions.
    • Immunizations: Controversies in Recommendations for Adults and Children
    • Cancer Risk: Cervical, Colorectal, Breast, Prostate: Pros and Cons of Screening
  • Hot Topics are short, newsworthy articles in a focused area of the diagnosis or management of HTN. These articles are designed to engage the participant in the topic area and lead them to content that provides the opportunity for more in-depth learning.
    • Screening for Osteoporosis: Who, When, How – or Maybe Not
    • Office Systems to Increase Prevention/Risk Reduction Among Your Patients
  • Interactive Minicases offer a valuable learning experience based on real-life scenarios of interactions between primary care physicians, the health practice team, and patients with HTN. This method of engagement allows participants to build their knowledge and competence as they engage and progress through case simulation of  both the clinical management of patients with HTN and some system-specific issues  in their practices.
    • Screening for HIV: Are You Starting Soon Enough?
    • Alcohol and Depression: Where Do You Intervene? 
    • Reducing Cardiovascular Risk: How to motivate patients to stop smoking, lose weight, exercise more
  • Point-of-Care Search CME (PoC) includes structured, self-directed online learning on topics relevant to their clinical practice. Learning for this activity occurs through a reflective process in which physicians document the clinical question, cite the sources consulted, and identify the application of the learning to their practice.
  • Clinical Resources and References provide a bibliography of cited evidence-based references and links to resources featured in this section.
  • Building Teamwork provides clinicians and non-clinical staff with resources, educational activities, and tools for promoting teamwork in their practice and collaborative strategies to achieve performance improvement.
  • Staff Resources Whether you’re a PA, NP, medical assistant, or staff receptionist, this site can help improve your knowledge and management of patients with chronic diseases.
  • Patient Resources provide patients with practical information and tools about their health and medical conditions to promote patient self-management and patient-physician partnerships.
  • Patient Centered Medical Home offers a stimulating set of concepts for bringing your practice into the 21st century – including updates on electronic health records and other government-supported programs.


Zalman S. Agus, MD, Editor-in-Chief
Associate Dean for CME
Emeritus Professor of Medicine
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania

Dr Agus is Executive Editor and Associate Dean for Continuing Medical Education and Emeritus Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania, and a recognized leader in medical education, medical journalism, and electronic media-based technologies in physician learning. Dr. Agus was previously Chief of the Renal and Electrolyte Section and Director of the Fellowship Training Program. He has published over 120 articles and textbook chapters and served as Coordinating Editor of UptoDate in Medicine. He was elected a member of the American Society for Clinical Investigation and is a Fellow of the American College of Physicians.

Doug Campos-Outcalt, MD, MPA, Faculty
Associate Head, Family and  Community Medicine
University of Arizona College of Medicine
Phoenix, Arizona

Dr. Campos-Outcalt is a practitioner and educator of public health and family medicine. He received his medical degree from the University of Arizona and completed residencies in Family Practice at the University of California, Davis and Preventive Medicine/Public Health at the University of Arizona. He also received a Masters in Public Administration from Arizona State University. Dr Campos-Outcalt has been a family physician in underserved Arizona communties, and has been a medical educator for 20 years. His research interests include applied public health practice methods, health workforce distribution, public health preparedness and the interface between public health and medicine.

Liana Lianov, MD, MPH, FACPM, Faculty
Associate Professor
Departments of Public Health Sciences and Internal Medicine
University of California
Davis, California

Dr. Lianov is President-Elect for the American College of Lifestyle Medicine and a board member of the American College of Preventive Medicine. She is board certified in both preventive medicine/public health and internal medicine and has completed a fellowship in consultation-liaison psychiatry. She recently served as Vice President of Clinical Operations at Berkeley HeartLab where she directed a national cardiovascular disease management program focused on health behavior change in nutrition, physical activity, medication adherence, and stress management. Dr. Lianov also previously directed the Healthy Lifestyles and Medicine and Public Health Divisions at the American Medical Association and served as Chief Medical Officer for Medical Quality at the California Department of Corrections and Rehabilitation. Dr. Lianov is also founder of HealthType—a health promotion consulting service

Medical Editor
Lewis Miller, MS, CCMEP
Principal, WentzMiller & Associates
Darien, Connecticut 

Medical Writers
Anne Greenberg, Medical Writer
Scottsdale, Arizona

Rick McGuire, Medical Writer
Scottsdale, Arizona

Program Directors
Chief Learning Officer

Mila Kostic, CME Director and Chief Learning Officer
Director of CME
Perelman School of Medicine at the University of Pennsylvania
Philadelphia, Pennsylvania

Chief Technology Officer
Lauren Patrick MS
President, NetHealth
Malvern, Pennsylvania

Editorial Director
Wendy Turell, DrPH, Editorial Director

Editorial Board
Joseph E. Scherger, MD, MPH, Editorial Board
Professor of Clinical Family and Preventive Medicine
Director, San Diego Center for Patient Safety
Medical Director, Quality Improvement Education
Director, Quality Improvement in Correctional Medicine
University of California, San Diego School of Medicine (USCD)
San Diego, California

Matthew H. Rusk, MD, Editorial Board
Associate Professor of Clinical Medicine
Program Director, Primary Care Program
Staff Internist, Division of General Medicine
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

Dennis F. Saver, MD,  Editorial Board
President and Staff Physician, Primary Care of the Treasure Coast
Clinical Assistant Professor of Family Medicine
Florida State University
Vero Beach, Florida

Peter J. Ziemkowski, MD,  Editorial Board
Assistant Professor, Department of Family Medicine
College of Human Medicine
Michigan State University
Clerkship Director and Physician/Faculty
Michigan State University–Kalamazoo Center for Medical Studies
Kalamazoo, Michigan

Patricia M. Bomalaski, MSN, CRNP, Editorial Board
Department of Medicine
Penn Center for Primary Care
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania

Jesse A. Coale, PA-C, Editorial Board
Assistant Professor Philadelphia University
Philadelphia, Pennsylvania

Michael A. Rackover, PA-C, MS, Editorial Board
Associate Program Director & Associate Professor Physician Assistant Program Philadelphia University
Philadelphia, Pennsylvania

Instructions for Obtaining CME Credit

To obtain Credit Certificate for CME-certified activities follow these steps:

  • Review the topic- and activity-specific overview
  • Complete the brief case-based pre-activity assessment
  • Review the entire educational activity
  • Answer all case-based questions in the post-activity assessment
  • Complete the evaluation
  • Proceed to view or print your certificate stored in your Personal Learning Center

The Perelman School of Medicine at the University of Pennsylvania is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation of Credit
These activities have been approved for AMA PRA Category 1 Credit(s)™.

Disclosure of Commercial Support
Supported, in part, by educational grants from Abbott Laboratories,  Daiichi Sankyo, Inc., Genentech, Inc., GlaxoSmithKline, Lilly USA LLC, and Takeda Pharmaceuticals North America, Inc.

Disclosures of Personal Financial Relationships
It is policy at the Perelman School of Medicine at the University of Pennsylvania for individuals who are in a position to control the content of an educational activity to disclose to the learners all relevant financial relationships that they have with any commercial interest that provides products or services that may be relevant to the content of these continuing medical education activities. For this purpose, we consider relationships of the person involved in the CME activity to include financial relationships of a spouse or partner.

The intent of this policy is not to prevent expert faculty with relevant relationship(s) with commercial interest(s) from involvement in CME, but rather to ensure that Penn CME-certified activities promote quality and safety, are effective in improving medical practice, are based on valid content, and are independent of control from commercial interests and free of commercial bias. Peer review of all content was conducted for all faculty presentations whose disclosure information provided to the Penn Office of CME was found to contain relationships that created a conflict of interest relative to the topic of their presentation. In addition, all faculty were instructed to provide balanced, scientifically rigorous, and evidence-based presentations.

The staff in the Office of CME at the University of Pennsylvania School of Medicine, Mila Kostic, and Zalman Agus, MD, have reported no relevant financial relationships with any commercial interests related to the content of these educational activities.

The following staff member and medical writers have reported no relevant financial relationships with any commercial interests related to the content of these educational activities:  
       Wendy Turell, DrPH
       Anne Greenberg
       Rick McGuire

The following staff members have reported the listed relevant financial relationships with commercial interests related to the content of these educational activities:
       Lewis A. Miller, MD, is a consultant for Takeda Pharmaceuticals North America, Inc.

The following editorial board members have disclosed that they have no relevant financial relationships with any commercial interests related to the content of these educational activities:  
      Patricia M. Bomalaski, MSN, CRNP
      Matthew Rusk, MD
      Joseph E. Scherger, MD, MPH
      Peter Ziemkowski, MD
      Jesse A. Coale, PA-C

The following editorial board members have reported the listed relevant financial relationships with commercial interests related to the content of these educational activities. 

Faculty Name

Name of Commercial Interest


Michael A. Rackover, PA- C, MS GSK Spouse is an employee
Dennis Saver, MD Boehringer Ingelheim
First Consult

Board Member

The following faculty have disclosed that they have no relevant financial relationships with any commercial interests related to the content of these educational activities:
      Doug Campos-Outcalt, MD
      Liana Lianov, MD, MPH, FACPM

Relevant Financial Relationships:
Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching, membership on advisory committees or review panels, board membership, and other activities from which remuneration is received or expected.

INVESTIGATIONAL AND/OR OFF-LABEL USE OF COMMERCIAL PRODUCTS AND DEVICES: The Perelman School of Medicine at the University of Pennsylvania requires all faculty to disclose any planned discussion of an investigational and/or off-label use of a pharmaceutical product or device within their presentation. Participants should note that the use of products outside FDA-approved labeling should be considered experimental and are advised to consult current prescribing information for approved indications.

The faculty reported that there will be no specific mentions of off-label and/or investigational use of products within their presentations.

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Which of your patients are you screening for cancer, and at what age and how often? How closely does your screening pattern follow the recommendations of the US Preventive Services Task Force (USPSTF)? Are there significant opinions contrary to the USPSTF recommendations?
The Patient Protection and Affordable Care Act of 2010 stipulates that Medicare and employer-provided and individual health insurance plans created after March 23, 2010, must cover in full all preventive services that receive a grade A or B recommendation from the USPSTF. Insurance carriers may choose, but are not required, to cover services that do not receive a grade A or B recommendation (see Table 1).
This is one of four CME activities that answer the questions about which screening tests to use for early detection of cancer. Each is presented in the context of a member of the Denkins family, new patients in your practice.
Once you have completed this activity on prostate cancer screening, you can return to this page and click on any of these links – screening for colorectal cancer, breast cancer, and cervical cancer – to compare your current practices with accepted guidelines – and also see where there are differences of opinion regarding these guidelines.
Learning Objectives: Upon completion of this educational activity on prostate cancer screening, the participant should be able to
  • Apply the most recent screening protocols for prostate cancer as outlined by the US Preventive Services Task Force and prominent cancer organizations
  • Communicate successfully with patients about frequency and methods of screening for prostate cancer
  • Help the patient decide on PSA screening, given the risks and benefits

Faculty Consultant: Liana Lianov, MD, MPH, FACPM
Medical Writer: Lewis A. Miller, MS; Caitlin Rothermel, MA, MPHc
Zalman S. Agus, MD
Original Date of Release: August 5, 2011
Last Review Date: August 5, 2011
Expiration Date: July 1, 2014
Estimated Time to Complete: 15 minutes
Amount of credit: Maximum of 0.25 AMA PRA Category 1 Credits
Accreditation: The Perelman School of Medicine at the University of Pennsylvania is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Designation of Credit: The Perelman School of Medicine at the University of Pennsylvania designates this enduring material for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Supported, in part, by educational grants from Abbott Laboratories, Daiichi Sankyo, Inc., Genentech, Inc., GlaxoSmithKline, Lilly USA LLC, Merck & Co., Inc., and Takeda Pharmaceuticals North America, Inc.


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