PEDIATRIC PREVENTIVE HEALTH CARE GUIDELINES

Transcription

1 PEDIATRIC PREVENTIVE HEALTH CARE GUIDELINES INFANCY AGE IMMUNIZA- NEWBORN 3-5 DAYS 48 o -72 o POST DISCHARGE By 1 MONTH 2 MONTHS Feeding Jaundice Hep B #1 (At Birthl) Hep B #1 IF NOT PREVIOUSLY GIVEN Hep B #2 Rotavirus #1 DTaP #1 Hib #1 PCV #1 IPV #1 Hep B #2 Hearing Screening Vision 4 MONTHS Rotavirus#2 DTaP #2 Hib #2 PCV #2 IPV #2 6 MONTHS 9 MONTHS Psychosocial/Behaviial Assessment Developmental Screening Psychosocial/Behaviial Assessment IF NOT PREVIOUSLY GIVEN Hep B #3 Rotavirus #3 DTaP #3 Hib #3 PCV #3 IPV #3 Infl uenza- Transition from PCV7 to PCV13 should be made as soon as the PCV 13 is available. CATCH-UP SCHED- ULE Vision Sreening Delayed and missed vaccinations contribute to under immunization which in turn increases individual and community risks to vaccine-preventable disease *Consider Combination Vaccines when Possible.* Guidelines are based on American Academy of Pediatrics Recommendations f Preventive Pediatric Health Care. These guidelines are f preventive care, other services may be required based on individual member s needs risk facts. The immunization schedule is based on the Recommended Immunization Schedule f persons aged 0-6 years-united States, 2010

2 PEDIATRIC PREVENTIVE HEALTH CARE GUIDELINES EARLY CHILDHOOD AGE 12 MONTHS Blood Lead Level* 18 MONTHS 24 MONTHS 3 YEARS Guidelines are based on the American Academy of Pediatrics Recommendations f Preventive Pediatric Health Care. These guidelines are f preventive care, other services may be required based on individual member s needs risk facts. The immunization schedule is based on the Recommended Immunization Schedule f persons aged 0-6 years-united States, 2010 *Required f Medicaid 15 MONTHS Body Mass Index () Blood Lead Level* *Required f Medicaid 30 MONTHS Body Mass Index () Body Mass Index () Developmental Screening Autism Screening Autism Screening Developmental Screening Hep B #3 DTaP #4 (6M after 3 Dose) HIB #4 PCV #4 IPV #3 MMR #1 Varicella #1 #1 SAME AS ABOVE Hep B#3 DTaP #4 (6M after 3 Dose) IPV #3 Refer to CDC Catch-Up Schedule if needed Refer to CDC Catch-Up Schedule if needed Refer to CDC Catch-Up Schedule if needed (If Indicated) Hemoglobin Hemoglobin Dyslipidemia Screening Hemoglobin 4 YEARS DTaP #5 Body Mass Index () IPV #4 Hemoglobin Lead Screening MMR #2 Varicella #2 Dyslipidemia Screening *All Children Months of age who have had 4 doses of PCV7 needs one dose of PCV13 per CDC. Delayed and missed vaccinations contribute to under immunization which in turn increases individual and community risks to vaccine-preventable disease *Consider Combination Vaccines when Possible *

3 5 Years 6 Years Height and Height and 7 Years Height and 8 Years Height and 9 Years Height and PEDIATRIC PREVENTIVE HEALTH CARE GUIDELINES MIDDLE CHILDHOOD Initial/Interval Psychosocial/behavial 10 Years Height and Physical Examination Unclothed Years Height and 11y-16y 18-21y Vision Test 12y,15y,18y Chlamydia (if sexually active) Pap testing begins age 21 at risk DTaP #5 IPV #4 MMR #2 Infl uenza yearly Varicella #2 AGE (If Indicated) Lead screening (If Indicated) Vision Test 11y, 13y 14y,16y, 17y, 19y-21y Hearing Test Alcohol & Drug Use 11-17y STI Cervical Dysplasia Delayed and missed vaccinations contribute to under immunization which in turn increases individual and community risks to vaccine-preventable disease AAP recommends annual visits ages 11y-21y. Other services may be required based on individual member s needs risk facts. *Consider Combination Vaccines when Possible * Guidelines are based on the American Academy of Pediatrics Recommendations f Preventive Pediatric Health Care. These guidelines are f preventive care, other services may be required based on individual member s needs risk facts. The immunization schedule is based on the Recommended Immunization Schedule f persons aged 7-18 years-united States, 2010 ADOLESCENCE Breast &/ Testicular Exam Psychosocial/behavial DTaP #5 IPV #4 MMR #2 Varicella # Year Olds TdaP MCV HPV Series of 3 - female Year Olds Tdap HPV Series MCV Hep B Series IPV Series MMR Series Varicella Series

4 ADULT PREVENTIVE CARE GUIDELINES Years Height Clinical Breast Exam - Annually* Osteoposis Screening 60-64* (if at risk) Colectal Screening > 50 Years of age * *(earlier if at risk) Fecal Occult Blood- Series of 3 - Annually AGE Years Pap Test - Ages every 2 years have a cervix < every 3 Height Colectal Screening > 50 Years of age* *(earlier if at Fasting lipoprotein profi le > 20 years every 5 years (Total Cholesterol, LDL, HDL and Triglycerides) FEMALE AGE Mammogram > 40 years (every 1-2 years) Fasting lipoprotein profi le > 20 years every 5 years (Total Cholesterol, LDL, HDL and Triglycerides) Chlamydia < 24 years of age increased risk Rubella serology/vaccination hx Fecal Occult Blood- Series of 3 - Annually Prostate Screening (as recommended by physician with infmed consent) MALE Obesity Screening Sexual Behavi/ Contraception Calcium Intake Obesity Screening Sexual Behavi Tdap x 1 dose; then Td HPV < 26 years x 3 doses MMR 1 2 doses year olds Zoster > 60 *Immunization at Risk Pneumococcal* Tdap x 1 dose; then Td MMR doses (20-49 year olds) Zoster > 60 *Immunization at Risk Group Pneumococcal* Guidelines are recommendations f periodic assessments from the United States Preventive Services Task Fce based on AHRQ Home/Clinical Infmation/U.S. Preventive Services Task Fce, American College of Obstetricians and Gynecologists guidelines f cervical cancer screening, NCEP (National Cholesterol Education Program) recommendations are the guidelines used f cholesterol screening. The Immunization Schedule is from the Recommended Adult Immunization Schedule, United States, These guidelines are f preventive health care, other services may be required based on individual member s needs and risk facts. MAC APPROVED

5 SENIOR ADULT PREVENTIVE CARE GUIDELINES AGE 65 and over FEMALE Height Clinical Breast Exam - Annually Colectal Screening Fecal Occult Blood series of 3 - Annually Osteoposis Screening Pap Test - Women who are sexually active & who have a cervix < every 3 years Consider discontinuation of testing after age 65 if previous regular screening results were consistently nmal. Mammogram (every 1-2 years) Fasting lipoprotein profi le every 5 years Injury Prevention, especially fall prevention Sexual Behavi Calcium Intake Urinary Incontinence Td - every 10 years Pneumococcal Zoster *Immunization at Risk Group MMR* MALE AGE 65 and over Height Td - every 10 years Pneumococcal Colectal Screening Zoster Fecal Occult Blood series of 3 - Annually Prostate Screening (as recommended by physician with infmed consent) Abdominal Atic Aneurysm with histy of smoking (one time screening) Fasting lipoprotein profi le every 5 years (Total Cholesterol, LDL, HDL and Triglycerides) Injury Prevention, especially fall prevention Sexual Behavi Urinary Incontinence *Immunization at Risk Group MMR* Guidelines are recommendations f periodic assessments from the United States Preventive Services Task Fce from AHRQ Home/Clinical Infmation/U.S. Preventive Services Task Fce. NCEP (National Cholesterol Education Program) recommendations are the guidelines used f cholesterol screening. The Immunization Schedule is from the Recommended Adult Immunization Schedule, United States, These guidelines are f preventive health care, other services may be required based on individual member s needs and risk facts.

6 Height - Current and Pre-pregnancy Physical Examination Ultrasound (if indicated) levels Urine f culture & sensitivity Pap Smear ABO/Rh Typing with antibody screen Rubella Antibody Titer VDRL RPR, FTA, if reactive Hepatitis B surface antigen HIV antibody testing One Hour Glucose Tolerance Test (at risk) Test f Gonrhea and Chlamydia (if indicated) Cystic Fibrosis Screening - (optional) (Offered if not done pri to pregnancy) Sickle Cell Screen - offered to African Americans Genetic Risk Assessment and Counseling Complete Estimated Date of Delivery Current Medication (Prescription & OTC) Tobacco Use Substance Use Signs and Symptoms to rept to provider Nutrition Environmental Exposure Hot Tub Warning Exercise Evaluate risk f domestic violence Infl uenza vaccine (if 2nd & 3rd trimester of pregnancy during fl u season) During the initial evaluation, the physician Certified Nurse Midwife needs to perfm a risk assessment. At risk pregnancies need to be referred to Paramount s Case Management Program f follow-up. In addition the initial evaluation needs to include documentation of these guidelines. Fundal Height Fetal Heart Tones Fetal Movement (to be recded each visit during the 2nd and 3rd trimester) Dipstick Presence of Contractions Presence of Edema Ultrasound (at risk) Sononuchal-lucency weeks (at risk) Infl uenza vaccine (if 2nd & 3rd trimester of pregnancy during fl u season) Breasts Abdomen Pelvic Exam Episiotomy Repair Uterine involution Pap Test (if needed) PRENATAL - INITIAL EVALUATION FOLLOW-UP VISITS Quadruple Screen at Weeks - offered (Alpha-fetoprotein, b-hcg, unconjugated Estriol, Inhipin-A) Antibody Screen at 28 weeks (if Rh Negative; pri to giving Rhogam) Hemoglobin Hematocrit (to be recded at weeks gestation) -CBC with differential (if Hemoglobin<10 Hematocrit< 32) -Iron studies if low MCV -Hemoglobin Electrophesis-recommended if indicated (consult with labaty f further recommendations) One Hour Glucose Tolerance Test at 28 weeks Group B Strep, Gonrhea, Chlamydia Weeks HIV antibody testing Genetic Studies (as indicated) VDRL RPR, FTA, if reactive (at risk) Interval Assess adaptation to newbn Physical Exam to evaluate status Breastfeeding Evaluate f Postpartum depression Birth Control Return to Wk Prenatal Risk Fact Rhogam (if appropriate) Exercise Childbirth Process Infant Feeding Choosing Child s Physician WIC/Nutrition Birth Control Wking Air travel during pregnancy Postpartum Tubal Ligation Circumcision Vaginal Birth After Cesarean (if indicated) Umbilical cd blood bank Follow-Up visits are scheduled every 4 weeks f the fi rst 28 weeks of gestation, every 2 weeks until 36 weeks of gestation and weekly thereafter. The frequency of follow-up visits is determined by the individual needs of the woman and assessment of her risks. POSTPARTUM VISITS Postpartum visits should be scheduled approximately 4-6 weeks after delivery. A visit within 7-14 days of delivery may be advisable after a cesarean delivery a complicated gestation. Guidelines are recommendations from Guidelines f Perinatal Care Sixth Edition. These are guidelines f members with an uncomplicated pregnancy. Other services may be required based on individual member s needs risk facts. Services should be perfmed as needed and are at the discretion of the provider. These guidelines are not considered as standards of care but are developed to enhance the clinician s practice. PARAMOUNT HEALTH CARE OFFERS 2 POSTPARTUM HOME VISITS FOR ALL ADVANTAGE MEMBERS; PLEASE ENCOURAGE OUR MEMBERS TO ACCEPT THESE VISITS AND USE THIS OPPORTUNITY TO HELP THEM ADJUST TO THEIR NEW RESPONSIBILITIES.