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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
- See Also
- Health Concerns in the Elderly
- Health Maintenance in Adolescents
- Health Maintenance in Children
- Healthcare of the College Student
- Preventive Health Care of Men Who Have Sex With Men
- Preventive Health Care of Women Who Have Sex With Women
- Health Care for Adults with Developmental Delay
- Healthcare of the Incarcerated Patient
- Health Care of the Homeless
- Epidemiology
- Preventive care visits for ages 15 to 65 years old (U.S.)
- Women: 44%
- Men: 15%
- Hsiao (2010) Natl Health Stat Report (27):1-32 [PubMed]
- Adults with primary care provider (U.S., 2000)
- Women: 80%
- Men: 66%
- Life Expectancy (U.S., 2015)
- Women: 82 years
- Men: 76 years
- Risk Factors: Health Disparities
- Racial and ethnic minorities
- Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) patients
- Uninsured
- Young adults
- Rural regions
- History
- Medical History
- Surgical History
- Medications
- Allergies
- Prevention: Habitus and Lifestyle
- Precautions: High Risk Settings may direct additional screening
- STI Clinics
- Correctional facilities
- Homeless Shelters
- Tuberculosis Clinics
- Adolescent Health Clinics
- Obesity
- If BMI >30, refer to intensive behavioral counseling
- See Obesity Management
- Physical Activity
- See Exercise Prescription
- Dietary Intake
- See Nutrition Guidelines
- Substance Abuse
- Tobacco Abuse
- See Tobacco Cessation
- Alcohol Abuse
- See Alcohol Abuse Screening
- Drug Abuse
- See Substance Abuse Evaluation
- See Single-Question Drug Abuse Screening Test
- Sexually Transmitted Disease
- See STD Screening
- Prevention (Condom Use, limit sexual partners, Immunizations)
- Gonorrhea and Chlamydia screening in age <25 years who are sexually active
- HIV Risk Factors and HIV Screening for age 15 to 65 years old
- HSV screening is NOT indicated in asymptomatic adults (including asymptomatic in pregnancy)
- See Hepatitis C Screening as below
- Initimate Partner Violence
- See Intimate Partner Violence Screening
- Major Depression
- See Depression Screening Tools (e.g. PHQ2, PHQ9)
- Consider starting with PHQ2, and if positive, reflex to PHQ9
- Osteoporosis
- See Osteoporosis Screening
- Prevention: Cardiovascular
- Coronary Artery Disease
- See Cardiovascular Risk Management
- ASCVD Risk Estimator
- https://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/
- Hypertension
- See Hypertension Evaluation
- Hyperlipidemia
- See Hyperlipidemia Management
- Indications
- Cardiovascular Risk Factors
- Start screening for men and women at age 20 years old
- No risk factors
- Men: Over age 40 years old
- Women: Over age 45 years old
- Screen every 5 years
- Fasting lipid profile or
- Total Cholesterol and HDL Cholesterol
- Abdominal Aortic Aneurysm
- See Ultrasound in Abdominal Aortic Aneurysm
- Indications (per USPTF)
- Men aged 65 to 75 years with lifetime Tobacco use greater than 100 Cigarettes
- Women have no screening guidelines per USPTF
- See Abdominal Aortic Aneurysm for broader screening guidelines per Society Vascular Medicine
- References
- (2005) Am Fam Physician 71(11):2144-8 [PubMed]
- Carotid Artery Stenosis Guidelines
- See Carotid Artery Stenosis
- Prevention: Cancer in Men and Women
- Colorectal Cancer
- See Colorectal Cancer Screening
- Indications
- Start screening at age 50 years (and stop between 75 and 85 years old)
- See Colorectal Cancer Screening regarding indications to start screening earlier
- Options
- Colonoscopy: Every 10 years (preferred) or
- Flexible Sigmoidoscopy: Every 5 years or
- Occult Blood in stool: Annually
- Lung Cancer
- Screening
- Indicated in age 55 to 80 years old with 30 py Tobacco use (ongoing or quit in last 15 years)
- Screen with annual low dose CT chest
- Advantages
- Number Needed to Screen in 5 years to prevent one death: 320
- All cause mortality Relative Risk Reduction: 6.7%
- Disadvantages
- Cummulative radiation and cost with annual screening will be substantial
- High False Positive Rate with screening (96%) will require significant resources to evaluate
- Despite USPTF recommendation for screening, other organizations (e.g. AAFP) do not recommend
- References
- Aberle (2011) N Engl J Med 365(5): 395-409 [PubMed]
- Gates (2014) Am Fam Physician 90(9): 625-31 [PubMed]
- Kovalchik (2013) N Engl J Med 369(3): 245-54 [PubMed]
- Prevention
- Tobacco Cessation
- Consider Radon Gas testing in the home
- USPTF Lung Cancer screening guidelines
- See Lung Cancer Screening CT Chest
- Skin Cancer
- See Self Skin Exam
- Counsel on reducing the risks of Sun Exposure (esp. in young, fair skinned patients)
- Insufficient evidence to recommend skin cancer screening (self screening, or that by a medical provider)
- Prevention: Women
- Precautions
- Routine pelvic exam is not indicated in asymptomatic non-pregnant women of child bearing age
- Exception: Cervical Cancer Screening protocols or other specific risk factors may indicate exam
- Oral Contraception does not require a pelvic exam
- Sexually Transmitted Infection
- See Sexually Transmitted Infection
- Sexually Transmitted Infection screening and prevention as above
- Screen women with HIV annually for Trichomonas
- Family Planning ("Would you like to become pregnant in the next year?")
- Contraception Counseling
- Unplanned Pregnancy accounted for 45% of pregnancies in 2011
- Finer (2016) N Engl J Med 374(9): 843-52 [PubMed]
- Preconception Counseling
- Folic Acid 400-800 mcg orally daily
- Cervical Cancer
- See Cervical Cancer Screening
- Pap Smears are not indicated under age 21 years old or after Hysterectomy for benign causes
- Pap Smear Intervals are typically at every 3 years for under age 30 in immunocompetent patients
- HPV testing may be considered after age 25 years
- Cervical Dysplasia and HPV results directs further testing
- Breast Cancer
- See Breast Cancer Screening
- Offer Mammograms every 1-2 years ages 40-50 years, and recommend routinely after age 50 years
- Consider BRCA testing in those with Family History of Breast Cancer or Ovarian Cancer
- Ovarian Cancer
- Routine screening not recommended (USPTF)
- Prevention: Men
- Sexually Transmitted Infection
- See Sexually Transmitted Infection
- Sexually Transmitted Infection screening and prevention as above
- Prostate Cancer
- See Prostate Cancer Screening
- Prostate Specific Antigen (PSA)
- See Prostate Cancer Prevention for an Informed Consent outline for PSA testing
- Discuss risks and benefits of test
- Not recommended by most organizations other than ACS and AUA
- Offer test annually between ages 55 to 69 years after discussion of test poor efficacy
- Previously indicated for ages 50 to 75 years
- Testicular Cancer
- See Testicular Self-Exam
- No routine screening recommended by USPTF or NCI
- Prevention: Eye
- Glaucoma
- See Intraocular Pressure
- Medicare will cover an annual dilated Eye Exam and Glaucoma screening
- Consider baseline exam indications
- Age over 40 years
- Family History of Glaucoma related Vision Loss
- Guidelines
- USPTF does not recommend routine screening
- Vision
- See Vision Screening
- Prevention: Miscellaneous
- Diabetes Mellitus
- See Diabetes Screening
- Diabetes Screening indications
- Treated or untreated Hypertension (BP >135/80)
- Overweight or obses adults 40 to 70 years old
- COPD
- See COPD
- Routine screening with Spirometry not recommended (USPTF)
- Hepatitis C
- See Hepatitis C
- Hepatitis C Screening indications
- All patients born between 1945 and 1965
- Patients at high risk of Hepatitis C (e.g. IV Drug Abuse)
- CDC Hepatitis C Screening Guidelines
- http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6104a1.htm
- Prevention: Immunizations
- Tetanus Vaccine
- Tetanus Vaccine given every 10 years
- Age under 65 years: Give Tdap (e.g. Adacel) once at next opportunity
- Age over 65 years: Give Tdap (e.g. Adacel) once if in contact with infants under age 1 year old
- Influenza Vaccine
- Annual Vaccine recommended in all patients
- See Influenza Vaccine for indications
- Pneumococcus Vaccine
- One dose over age 65 years or Asplenic
- MeaslesVaccine
- Booster for 1 dose if born after 1956
- RubellaVaccine
- Fertile woman without proof of Immunity
- Tuberculin Skin Test (Purified Protein Derivative)
- Recommended for high risk patients for Tuberculosis
- Hepatitis B Screening and Immunization
- See Hepatitis B Vaccine for Immunization indications
- See Hepatitis B Serology for screening indications
- HPV Vaccine
- Included in Primary Series and indicated to age 26 (age 45 if high risk) in men and women
- Meningococcal Vaccine
- Included in Primary Series (at ages 11-12, and booster at age 16-18)
- Consider in unvaccinated adults with risk factors (e.g. military barracks, HIV Infection, travel to high risk areas)
- Shingles Vaccine (Herpes Zoster Vaccine)
- Two doses for over age 50 years
- Varicella Vaccine
- Adults born after 1980 without confirmed Immunity
- CDC Immunization Schedules
- http://www.cdc.gov/vaccines/recs/schedules/default.htm
- References
- Heidelbaugh (2018) Am Fam Physician 98(12): 729-37 [PubMed]
- Heidelbaugh (2012) Am Fam Physician 85(10): 964-71 [PubMed]
- Paladine (2021) Am Fam Physician 103(4): 209-17 [PubMed]
- Riley (2012) Am Fam Physician 87(1): 30-7 [PubMed]