2010 Adult Preventive Schedule: Ages 19 through 64 Years

Transcription

1 : Ages 19 through 64 Years History and Physical History and Physical Exam Description A physical should be performed every one to two years for adults ages 19-49, and every year for adults ages 50 and older. Female PE: -Discuss preconception guidelines as appropriate -Annual pelvic/breast exam References Note: The specific references are listed in their entirety beginning on page 8 of this document The expert consensus opinion of the 2004 PH Committee 3. ACOG (2006) Pelvic/Breast Exam Annually for females 1. ACOG (2006) Regular Weight, Height and BMI 1. AAFP (1996) Updated 2003 Monitoring 2. CDC (2004) Comments Blood Pressure At every provider visit beginning at age 18 years, with a minimum of once every 2 years or annually if diastolic > 85 or systolic > 130 mmhg NIH (1997) Updated 2004 Depression Periodic screening at the time of a focused exam, screen all patients with a depression screening tool such as the two-question depression screen recommended by the US Preventive Services Task Force. Over the past two weeks, have you felt down, depressed, irritable or hopeless? Over the past two weeks, have you felt little interest or pleasure in doing things? Yes response to either question indicates the need for a further depression assessment Page 1 of 11

2 History and Physical Lipid Panel Description Routine screening every five years beginning at age 20 and more frequent testing of those 20 years of age and older at risk for cardiovascular disease. References Note: The specific references are listed in their entirety beginning on page 8 of this document NCEP (2004) 3. The expert consensus opinion of the 2004 PH Committee Comments Mammography Recommend screening mammography, with or without clinical breast exam, every 1-2 years for women age 40 and older ACS 1997 Update 2006 West Virginia state law mandates payment associated with a mammogram every year for women 50 years of age or older and with any mammogram based on physician s recommendations for women under 40 years of age. Baseline screening should occur between the age of 35-39, and every two years between the ages of Even though most Mountain State products pay for mammograms, some employer groups (such as employer groups outside of West Virginia) and/or plans administered by Mountain State will not pay for part or all of the recommended West Virginia state mandated mammograms. The USPSTF recommends women should be informed of potential benefits, limitations, and possible harms of mammography in making decisions about when to begin screening. West Virginia state law mandate follows the original recommendation of the USPSTF Guidelines for Mammograms Baseline mammogram for women age A mammogram for women 40-49, inclusive, every 2 years or more often based on doctor s recommendation. A mammogram every year for women 50 and older. ACS Page 2 of 11

3 History and Physical Description Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health. References Note: The specific references are listed in their entirety beginning on page 8 of this document. Comments Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian cancer Susceptibility Fasting Plasma Glucose Women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing. Any one of the following indicates a risk of having a BRCA mutation: Personal and/or family history of breast cancer diagnosed under the age of 50. Personal and/or family history of ovarian cancer at any age. Women of Ashkenazi Jewish ancestry diagnosed with breast cancer or ovarian cancer at any age, regardless of family history. Personal and/or family history of male breast cancer. Affected relatives with a known BRCA1 or BRCA2 mutation. Bilateral breast cancer, especially if diagnosed at an early age. Breast cancer and ovarian cancer in the same person. Note: Recommend annual breast MRI screening as an adjunct to mammography BRCA mutation First-degree relative of BRCA carrier, but untested of high-risk patients should be considered by their physician beginning at age 45 at 3-year intervals or at a frequency that is clinically indicated. Testing for diabetes should be considered at a younger age or carried out more frequently in individuals who have additional risk factor (s). USPSTF recommends screenings for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) 1. USPSTF (2005) 2. AMA ACS ADA (2004) 2. USPSTF (June, 2008) Page 3 of 11

4 History and Physical Description greater than 135/80mm Hg. References Note: The specific references are listed in their entirety beginning on page 8 of this document. Comments Papanicolaou Test (Pap smear) Pap test every 1 to 3 years based on history, beginning approximately 3 years after initiation of sexual intercourse or at age 21, whichever comes first. Pelvic exam done yearly for clinical factors, and pap smear done for all those who are or have been sexually active AAFP (1996) Updated ACOG (2003) Women who have undergone hysterectomy with removal of the cervix for benign indications and who have no prior history of CIN 2 or CIN 3 or worse may discontinue routine cytology testing. * Women age 30 and older - There are two acceptable screening options for women in this age group 1. Testing using cervical cytology alone: If a woman age 30 or older has negative results on three consecutive annual cervical cytology tests, then she may re-screen with cervical cytology alone every 2-3 years. 2. The combined use of cervical cytology test and an FDA-approved test for high-risk types of HPV: Under this option women receive both a cervical cytology test and a test that looks for certain high-risk types of the human papillomavirus (HPV) known to cause cancer (HPV DNA test). Once women test negative on both tests they should be rescreened with the combined tests no more frequently than every 3 years. If only one of the tests is negative, however, more frequent screening will be necessary. (The combined testing is not appropriate for women under age 30, since they frequently test positive for HPV that will clear up on its own.) Page 4 of 11

5 History and Physical Description The USPSTF concludes that the evidence is insufficient to recommend for or against new technologies (such as liquid-based technologies) in place of conventional Pap tests. References Note: The specific references are listed in their entirety beginning on page 8 of this document. Comments Testing Description References Comments Chlamydia / Gonorrhea and other STD Chlamydia: Routine screening for all sexually active nonpregnant young women aged 24 and younger and for older non-pregnant women who are at risk. Options for Chlamydia : Amplified DNA-urine Cervical probe Urethral Probe USPSTF (1996) Updated 2007 CDC 2006 Gonorrhea: females at high risk of infection Human immunodeficiency virus (HIV) Screen all patients at increased risk for HIV infection., also consider blood-borne exposure, such as blood transfusion. Syphilis Screen all patients at increased risk for syphilis The CDC recommends routine voluntary HIV screening for all persons years old in health care settings not based on risk; however the USPSTF concluded there is insufficient evidence to recommend either for or against routinely screening for HIV adolescents and adults who are not at an increased risk for infection. Page 5 of 11

6 Testing Description References Comments Screen men and women 50 years of age or older for colorectal cancer Colorectal Cancer Regular screening for colorectal cancer with: Colonoscopy every 10 years or, Fecal occult blood test annually (home 3- pack FOBT test or fecal immunochemical test) or, Flexible sigmoidoscopy every 5 years or, Annual fecal occult blood test (home 3 pack FOBT test or fecal immunochemical test) plus flexible sigmoidoscopy every 5 years or, Double contrast barium enema every 5 years or, Note: Currently, flexible sigmoidoscopy together with FOBT is preferred when compared to FOBT or flexible sigmoidoscopy alone. All positive tests should be followed up with colonoscopy. People with a family or personal history of colon cancer or polyps, or history of chronic inflammatory bowel disease should be tested earlier, and may need to undergo testing more often. FOBT done in a physician office with the single negative stool sample collected during the rectal examination is not an adequate substitute for any of the screening options listed above. Note: ACOG recommends colonoscopy as the preferred method for colorectal cancer screening for both average-risk and high-risk women. 1. AAFP (1996) Updated USPSTF (1996) Updated American Cancer Society (2004) 4. ACOG 2007 Bone Mineral Density Postmenopausal women under 65 yr of age who have had a fracture or have one or more risk factors for osteoporosis. Recommended only once every two years. Bone mineral density studies for asymptomatic patients are considered screening. Refer to NOF Table 1: Risk Assessment National Osteoporosis Foundation (1998) Refer to NOF Page 6 of 11

7 Testing Description References Comments Table 2A: Medical Conditions That May Be Associated With An Increased Risk Of Osteoporosis & Table 2B: Drugs That May Be Associated With Reduced Bone Mass In Adults Prostate Cancer If screening is deemed appropriate, discuss risks/benefits of prostate cancer screening. Testing may include PSA (Prostate Specific Antigen) testing and/or digital rectal exam. 1. AAFP (2002) 2. USPSTF (1996) Updated NEJM (March, 2009) Page 7 of 11

8 Anticipatory Guidance/Safety Issues References Comments 1. AAFP (2001) Updated USPSTF (1996) Updated ACOG (2000) Updated NOF, 2009 Anticipatory Guidance/Psychosocial Anticipatory Guidance/Psychosocial to include: Second hand smoke Smoking cessation Substance abuse Nutrition Exercise At least 800-1,000 units of vitamin D daily and consideration of screening in persons with low sun exposure or other risk factors 1,200 mg. of calcium daily in adults 50 years and older. Women of childbearing age should have a daily consumption of Folic Acid 0.4 mg Aspirin use for at risk candidates plus men age 45 to 79 when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage. Aspirin use in women age 55 to 79 when the potential benefit due to a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. Discussion of risks and benefits of hormone replacement prophylaxis and alternative therapies in women Polypharmacy Safe sex/std HIV Sun exposure Oral health Safety Issues Safety Issues to include: Domestic Violence Smoke and carbon monoxide detectors Firearms use and safe storage of Appropriate protective/safety equipment for such activities as biking, skating and skiing Seat belt use for Alcohol Use in Adults The USPSTF recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women at the time of the physical exam. The AAFP recommends counseling adults who are problem drinkers regarding the dangers of driving while intoxicated and the risk of automobile accidents. Assessment of substance abuse using the Alcohol Use Disorders Identification Test [AUDIT] or equivalent tool. Page 8 of AAFP (2001) 2. USPSTF (1996) 3. ACOG (2000) AAFP (1996) Updated 2003

9 : Ages 19 through 64 years Reference Page References: 1. CDC (2005) 2. CDC (2005) 3. American Academy of Family Physicians. Summary of Policy Recommendations for Periodic Health Examination. Kansas City, MO: American Academy of Family Physicians; Revised USPSTF Guidelines Support for Alcohol Use in Adults, April 8, DNA Test For Chlamydia, January 28, BMI: Body Mass Index. April 17, US Preventive Services Task Force. (1996). Guide to Clinical Preventive Services, 2 nd Ed. Baltimore: Williams & Wilkins US Preventive Services Task Force. Washington, DC: US Department of Health and Human Services;. 9. American College of Obstetricians and Gynecologists. Primary and Preventive Care: Periodic Assessments. Washington, DC: National Institutes of Health (1999) American Diabetes Association (ADA), (2005). Clinical Practice Recommendations for for Diabetes. 12. National Institutes of Health. (1997) The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (NIH Publication No ). Bethesda, Maryland: National Heart, Lung & Blood Institute Information Center American Cancer Society (2004) American Cancer Society Guidelines on and Surveillance for the Early Detection of Adenomatous Polyps and Colorectal Cancer National Osteoporosis Foundation (1998) The Physicians Guide to Prevention and Treatment of Osteoporosis. 15. Andriole,M.D. G.L., & Crawford, M.D. E.D.(2009). Mortality results from a randomized prostate-cancer screening trial The New England Journal of Medicine, 360, Schroder, M.D., F.H., & Hugosson, M.D., J (2009). and prostate-cancer mortality in a randomized European study The New England Journal of Medicine, 360, Page 9 of 11

10 : Ages 19 through 64 years Resource Page Some flexibility in specific cases will require deviations from guideline recommendations. All providers are responsible for individualizing recommendations to the specific clinical characteristics of each patient Resources for Your Mountain State Patients Blues On Call SM nurse Health Coaches are available 24/7 to provide one-on-one telephonic support for patients regarding chest pain and many other health topics. Your Highmark patients can reach Blues On Call at (1-888-BLUE 428) toll free. The following on-line Improve Your Health HealthMedia programs are available at Succeed - An online Health Risk and Productivity Assessment that identifies individual risk, readiness and confidence to make lifestyle changes. Balance A weight management program. Nourish A nutrition program. Breathe A smoking cessation program. Relax A stress management program. Care for Your Health A self management program for chronic conditions. Care for Diabetes A diabetes management program. Care for Pain A chronic pain management program. Care for Your Back A customized program to assess, prevent and manage back pain. Overcoming Depression - A depression management program. Overcoming Insomnia A sleep improvement program. Overcoming Binge Eating A program that helps individuals experience a healthier, more satisfying relationship with food. To access Mountain State s Improve Your Health programs, direct your Mountain State patients to: Go to Mountain State s member website at and select the web address for the plan that serves them. Log in to the member website. Not registered? Select click here to get a password. Click the tab heading on the top of the home page called Your Health and then select Improve Your Health from the list of topics on the left side of the page Telephonic Smokeless tobacco cessation programs can be accessed by calling The following lifestyle improvement programs are offered regionally through the Preventive Health Services Alliance. For more information, call Eat Well for Life, a hands on nutrition program for life-long weight management. Discover Relaxation Within, to help manage stress. Clear the Air, to help you quit smoking. Page 10 of 11

11 Personal Nutrition Coaching, individual nutrition coaching by a registered dietitian to address weight management, heart health, or diabetes. Diabetes Awareness and Prevention, addresses preventing and managing diabetes. HOPE Osteoporosis Prevention and Education Program, focuses on healthy choices to prevent or manage osteoporosis. The Dr. Dean Ornish Program for Reversing Heart Disease is currently available at select regional locations. Participants in this lifestyle improvement program have experienced improved lipid panels, weight loss, decreased blood pressure, and better blood glucose control. (Applicants with Diabetes, CHD or risk factors may qualify). Coverage for the Dean Ornish program varies by Highmark plan and members should call the 800 number on the back of their insurance card for eligibility information. Ornish Advantage is an educational program using the tenets of the Dr. Dean Ornish Program for Reversing Heart Disease for individuals who want to prevent heart disease, reduce the risks for developing a chronic disease or learn lifestyle changes that can help manage diabetes, hypertension, and heart disease. For more information about The Dr. Dean Ornish Program for Reversing Heart Disease or Ornish Advantage call Mountain State s Online Complementary Wellness Discount Program offers savings of up to 30% on non-covered services and more. To access Mountain State s Complementary Wellness Discount Program, direct your Mountain State patients to: Go to Mountain State s website at and select the web address for the plan that serves them. Log in to the member website. Not registered? Select click here to get a password. Select Choose Providers, select the link to Member Discounts, and then the Wellness Discount Program. Or call for more information. As with any insurance, members are eligible for services only as long as they are active members of the plan and the services are covered benefits of their group or direct pay contract. Page 11 of 11