Prevention Book

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Adult Health Maintenance Screening

Aka: Adult Health Maintenance Screening, Health Maintenance in Adults, Well Woman Exam, Well Male Exam, Health Maintenance in Women, Health Maintenance in Men
  1. See Also
    1. Health Concerns in the Elderly
    2. Health Maintenance in Adolescents
    3. Health Maintenance in Children
    4. Healthcare of the College Student
    5. Preventive Health Care of Men Who Have Sex With Men
    6. Preventive Health Care of Women Who Have Sex With Women
    7. Health Care for Adults with Developmental Delay
    8. Healthcare of the Incarcerated Patient
    9. Health Care of the Homeless
  2. History
    1. Medical History
    2. Surgical History
    3. Medications
    4. Allergies
  3. Epidemiology
    1. Preventive care visits for ages 15 to 65 years old (U.S.)
      1. Women: 44%
      2. Men: 15%
      3. Hsiao (2010) Natl Health Stat Report (27):1-32 [PubMed]
    2. Adults with primary care provider (U.S., 2000)
      1. Women: 80%
      2. Men: 66%
    3. Life Expectancy (U.S., 2015)
      1. Women: 82 years
      2. Men: 76 years
  4. Prevention: Habitus and Lifestyle
    1. Precautions: High Risk Settings may direct additional screening
      1. STI Clinics
      2. Correctional facilities
      3. Homeless Shelters
      4. Tuberculosis Clinics
      5. Adolescent Health Clinics
    2. Obesity
      1. If BMI >30, refer to intensive behavioral counseling
      2. See Obesity Management
      3. USPTF Obesity Guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsobes.htm
    3. Physical Activity
      1. See Exercise Prescription
      2. USPTF Exercise Guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsphys.htm
    4. Dietary Intake
      1. See Nutrition Guidelines
      2. USPTF Dietary Guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsdiet.htm
    5. Substance Abuse
      1. Tobacco Abuse
        1. See Tobacco Cessation
        2. USPTF Tobacco guidelines
          1. http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac2.htm
      2. Alcohol Abuse
        1. See Alcohol Abuse Screening
        2. USPTF Alcohol guidelines
          1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsdrin.htm
      3. Drug Abuse
        1. See Substance Abuse Evaluation
        2. See Single-Question Drug Abuse Screening Test
        3. USPTF Drug use guidelines
          1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsdrug.htm
    6. Sexually Transmitted Disease
      1. Prevention (Condom Use, limit sexual partners)
      2. STD Screening
      3. HIV Risk Factors and HIV Screening
      4. USPTF Sexually Transmitted Disease guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsstds.htm
    7. Major Depression
      1. Depression Screening Tools (e.g. PHQ2, PHQ9)
        1. Consider starting with PHQ2, and if positive, reflex to PHQ9
      2. USPTF Depression Screening
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsaddepr.htm
    8. Osteoporosis
      1. USPTF Osteoporosis Guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsoste.htm
  5. Prevention: Cardiovascular
    1. Coronary Artery Disease
      1. See Cardiovascular Risk Management
      2. ASCVD Risk Estimator
        1. https://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/
      3. USPTF Coronary Heart Disease Guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsacad.htm
        2. http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm
    2. Hypertension
      1. See Hypertension Evaluation
      2. USPTF Hypertension Guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspshype.htm
    3. Hyperlipidemia
      1. Indications
        1. Cardiovascular Risk Factors
          1. Start screening for men and women at age 20 years old
        2. No risk factors
          1. Men: Over age 40 years old
          2. Women: Over age 45 years old
      2. Screen every 5 years
        1. Fasting lipid profile or
        2. Total Cholesterol and HDL Cholesterol
      3. USPTF Dysplipidemia guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspschol.htm
    4. Abdominal Aortic Aneurysm
      1. Screening with Ultrasound (Indications per USPTF)
      2. Indications
        1. Men aged 65 to 75 years with lifetime Tobacco use greater than 100 Cigarettes
        2. Women have no screening guidelines per USPTF
        3. See Abdominal Aortic Aneurysm for broader screening guidelines per Society Vascular Medicine
      3. USPTF AAA screening guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsaneu.htm
      4. References
        1. (2005) Am Fam Physician 71(11):2144-8 [PubMed]
    5. Carotid Artery Stenosis Guidelines
      1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsacas.htm
  6. Prevention: Cancer in Men and Women
    1. Colorectal Cancer
      1. See Colorectal Cancer Screening
      2. Indications
        1. Start screening at age 50 years (and stop between 75 and 85 years old)
        2. See Colorectal Cancer Screening regarding indications to start screening earlier
      3. Options
        1. Colonoscopy: Every 10 years (preferred) or
        2. Flexible Sigmoidoscopy: Every 5 years or
        3. Occult Blood in stool: Annually
      4. USPTF Colorectal Cancer Screening guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm
    2. Lung Cancer
      1. Screening
        1. Indicated in age 55 to 80 years old with 30 py Tobacco use (ongoing or quit in last 15 years)
        2. Screen with annual low dose CT chest
        3. Advantages
          1. Number Needed to Screen in 5 years to prevent one death: 320
          2. All cause mortality Relative Risk Reduction: 6.7%
        4. Disadvantages
          1. Cummulative radiation and cost with annual screening will be substantial
          2. High False Positive Rate with screening (96%) will require significant resources to evaluate
          3. Despite USPTF recommendation for screening, other organizations (e.g. AAFP) do not recommend
        5. References
          1. Aberle (2011) N Engl J Med 365(5): 395-409 [PubMed]
          2. Gates (2014) Am Fam Physician 90(9): 625-31 [PubMed]
          3. Kovalchik (2013) N Engl J Med 369(3): 245-54 [PubMed]
      2. Prevention
        1. Tobacco Cessation
        2. Consider Radon Gas testing in the home
      3. USPTF Lung Cancer screening guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspslung.htm
    3. Skin Cancer
      1. See Self Skin Exam
      2. Insufficient evidence to recommend skin cancer screening (self screening, or that by a medical provider)
  7. Prevention: Women
    1. Family Planning
      1. Contraception Counseling
      2. Preconception Counseling
        1. Folic Acid 400-800 mcg orally daily
    2. Cervical Cancer
      1. See Cervical Cancer Screening
      2. USPTF Cervical Cancer Screening
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm
    3. Breast Cancer
      1. See Breast Cancer Screening
      2. USPTF Breast Cancer Screening
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
    4. Ovarian Cancer
      1. Routine screening not recommended (USPTF)
      2. USPTF Ovarian Cancer Screening
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsviseld.htm
  8. Prevention: Men
    1. Prostate Cancer
      1. Prostate Specific Antigen (PSA)
        1. See Prostate Cancer Prevention for an Informed Consent outline for PSA testing
        2. Discuss risks and benefits of test
          1. Not recommended by most organizations other than ACS and AUA
        3. Offer test annually between ages 55 to 69 years after discussion of test poor efficacy
          1. Previously indicated for ages 50 to 75 years
      2. USPTF Prostate Cancer Screening guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsprca.htm
    2. Testicular Cancer
      1. No routine screening recommended by USPTF or NCI
      2. USPTF Testicular Cancer screening
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspstest.htm
  9. Prevention: Eye
    1. Glaucoma
      1. Medicare will cover an annual dilated Eye Exam and Glaucoma screening
      2. Consider baseline exam indications
        1. Age over 40 years
        2. Family History of Glaucoma related Vision Loss
      3. USPTF Glaucoma screening guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsglau.htm
        2. USPTF does not recommend routine screening
    2. Vision
      1. USPTF Visual Acquity Guidelines (older adults)
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsviseld.htm
  10. Prevention: Miscellaneous
    1. Diabetes Mellitus
      1. Diabetes Screening indications
        1. Treated or untreated Hypertension (BP >135/80)
        2. Overweight or obses adults 40 to 70 years old
      2. USPTF Diabetes Mellitus Guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspsdiab.htm
    2. COPD
      1. Routine screening with Spirometry not recommended (USPTF)
      2. USPTF COPD Guidelines
        1. http://www.uspreventiveservicestaskforce.org/uspstf/uspscopd.htm
    3. Hepatitis C
      1. Hepatitis C Screening indications
        1. All patients born between 1945 and 1965
        2. Patients at high risk of Hepatitis C (e.g. IV Drug Abuse)
      2. CDC Hepatitis C Screening Guidelines
        1. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm
  11. Prevention: Immunizations
    1. Tetanus Vaccine
      1. Tetanus Vaccine given every 10 years
      2. Age under 65 years; Give Tdap (e.g. Adacel) once at next opportunity
      3. Age over 65 years: Give Tdap (e.g. Adacel) once if in contact with infants under age 1 year old
    2. MeaslesVaccine
      1. Booster for 1 dose if born after 1956
    3. RubellaVaccine
      1. Fertile woman without proof of immunity
    4. Influenza Vaccine
      1. Annual Vaccine recommended in all patients
      2. See Influenza Vaccine for indications
    5. Pneumococcus Vaccine
      1. One dose over age 65 years or Asplenic
    6. Tuberculin Skin Test (Purified Protein Derivative)
      1. Recommended for high risk patients for Tuberculosis
    7. Hepatitis B Screening and Immunization
      1. See Hepatitis B Vaccine for Immunization indications
      2. See Hepatitis B Serology for screening indications
    8. HPV Vaccine
      1. Included in Primary Series and indicated to age 26 (age 45 if high risk) in men and women
    9. Shingles
      1. One dose over age 60 years (consider for age over 50 years)
    10. CDC Immunization Schedules
      1. http://www.cdc.gov/vaccines/recs/schedules/default.htm
  12. References
    1. Heidelbaugh (2018) Am Fam Physician 98(12): 729-37 [PubMed]
    2. Heidelbaugh (2012) Am Fam Physician 85(10): 964-71 [PubMed]
    3. Riley (2012) Am Fam Physician 87(1): 30-7 [PubMed]

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