Preventive services recommendations for adults in primary care settings: agreement between Canada, France and the USA--a systematic review

Objective: To analyze the level of agreement between recommendations on preventive services developed by Canada, France and the USA.

Methods: We gathered recommendations on primary and secondary preventive services to adults up to November 3rd, 2011 from Canadian and US Task Forces, and equivalent French agencies. We excluded recommendations on immunization, long-term diseases or pregnancy.

Results: Among 250 recommendations, 84 (34%) issued by a single country could not be compared; 43 (26%) of the remaining 166 were in strong agreement (strictly identical grades between advising countries); 25 of 43 resulted in a proposal to be implemented in clinical practice, two others not to be implemented in clinical practice and 16 were indeterminate about implementation. Strong agreement was more frequent for recommendations concerning history-taking and physical examination than for those concerning interventions (odds ratio (OR)=11.3, 95%CI: 1.6-241.2; p=0.04), and for recommendations concerning a high-risk population than for those concerning the general population (OR=3.1, 95%CI: 1.4-7.0; p=0.006). Agreement did not differ either according to maximum time range between recommendations' publication or according to the advising country.

Conclusion: Agreement between recommendations is low particularly on those concerning non-clinical preventive services or non-high-risk individuals.