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Preventive Medicine in Adults
- 1. Preventive Medicine in Adults Overview of USPSTF Recommendations Bita Fakhri, MD, MPH Shapiro Primary Care Clinic – 07/11/2013
- 2. Specific Conditions: Cardiovascular Disease Hypertension Abdominal Aortic Aneurysm Carotid artery stenosis Peripheral artery disease Cancer morbidity and mortality Breast cancer Cervical cancer Colorectal cancer Lung cancer Prostate cancer Melanoma
- 3. Specific Conditions (cont’d) Depression Diabetes mellitus Immunization Injury prevention Falls and bone fractures Motor vehicle crashes Intimate partner violence Lifestyle-related problems (#firstworldproblems) Obesity and physical inactivity Sexually-transmitted and other blood-borne infections
- 4. Specific Conditions (cont’d) Substance-abuse related problems (alcohol, tobacco) Vision and hearing problems
- 5. Detailed Recommendations of USPSTF Cardiovascular disease Service Target Population Screening for abdominal aortic aneurysm Ever-smoking men ages 65-75 years Aspirin for primary prevention of cardiovascular events Men: 45-79 – women: 55-79, when potential benefit outweighs potential harm due to increased risk of GI bleeding Behavioral dietary counseling Adults at increased risk Screening for dyslipidemia Average risk men age> 35 years Average risk women age >45 Increased risk men and women age > 20 Screening for HTN Adults age >18
- 6. Detailed Recommendations of USPSTF Cancer Screening for breast cancer with mammography (biennial) Women age > 40 years Family hx of risk assessment and referral for BRCA mutation counseling concerning breast and ovarian cancer susceptibility Women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 Discussion of chemoprevention of breast cancer Women at increased risk of breast cancer and decreased risk of adverse events Screening for cervical cancer with pap-smear (every three years) Women ages 21-65 who have been sexually active and have a cervix Screening for CRC Adults ages 50-75 Counseling to prevent skin cancer Adolescents and young adults ages 10-24 with fair skin
- 7. Detailed Recommendations of USPSTF Depression Adults within a system of care Diabetes Mellitus Adults with BP> 135/80 Fall prevention – exercise or physical therapy and vit D supplementation Community dwelling adults age > 65 at increased risk for falls Lifestyle-related problems Intensive behavioral dietary counseling Adults with hyperlipidemia or other risk factors Screening for obesity with intensive counseling and behavioral interventions Adults Screen for tobacco use and provide tobacco Adults and pregnant women
- 8. Detailed Recommendations of USPSTF Sexually transmitted infections Behavioral counseling to prevent sexually transmitted diseases Sexually active adolescents; adults at high risk Screening for chlamydia Non-pregnant sexually active women < 25 years; others at increased risk Screening for gonorrhea Women at increased risk Screening for HIV Pregnant women; all adolescents and adults ages 15-65; others at increased risk Screening for syphilis Pregnant women
- 9. Detailed Recommendations of USPSTF Other conditions Screening for asymptomaticbacteriuria Pregnant women Brief interventions or peer counseling to promote breast feeding Women after childbirth Screening for hepatitis B Pregnant women Screening for osteoporosis Women ages > 65 years; younger women with fracture risk equal to or greater than 65-year-old white woman with no additional risk factor Screening for intimate partner violence Women of childbearing age
- 10. Screening and prevention, adults younger than 50 years Priority health problem Effective preventive intervention Cancer – cervical cancer Screening with pap smear for women ages 21-65; every 3 years if sexually active and if previously normal results Depression Brief screening; follow-up if positive; treatment if needed Injuries Motor vehicle crashes Screen for alcohol miuse; brief counseling with follow-up if positive Domestic violence Be alert for early signs and symptoms Lifestyle- related problem s Obesity Discuss problem with patient; refer obese and physically inactive people to intensive, multidisciplinary programsPhysical inactivity
- 11. Screening and prevention, adults younger than 50 years (cont’d) Priority health problem Effective preventive intervention Sexually- transmitted infections Chlamydia Screen sexually active women ages 15-25 for chlamydia; plus older women who have had a previous infection Gonorrhea Screen young, sexually active women who live in high risk areas for gonorrhea HIV Screen people with either an individual risk factor or who receive health care in a high prevalence setting Substance abuse Tobacco 5 A’s*, offer nicotine replacement and bupropion, follow up Alcohol Screen for alcohol misuse; brief counseling with follow-up if positive Ask, advise, assess, assist, arrange
- 12. Screening and Prevention, adults older than 50 years Priority health problem Effective preventive intervention Cardiovascular disease Heart attack and stroke Blood pressure control Treatment of dyslipidemia Consider ASA, especially in men and women at increased risk Tobacco cessation counseling Abdominal aortic aneurysm One time screening with US for male smokers between the ages of 65 and 75 Cancer Lung cancer Tobacco cessation counseling CRC Screening (decide among tests) Breast cancer Screening mammography and clinical breast examination Prostate cancer Discuss screening Cervical cancer Pap smear every 3 years unless recent abnormality
- 13. Screening and Prevention, adults older than 50 years (cont’d) Priority health problem Effective preventive intervention Depression Brief screening; follow-up if positive; treatment if needed Diabetes Stay alert for symptoms; treat risk factors in people with diabetes Immunization- preventable diseases Influenza (50 and older) Annual influenza vaccination Severe pneumococcal disease (65 and older) Pneumococcal vaccine once Herpes zoster (60 years and older) Herpes zoster vaccine once
- 14. Screening and Prevention, adults older than 50 years (cont’d) Priority health problem Effective preventive intervention Injuries Falls and bone fractures (65 and older) Minimize psychotropic meds Encourage physical activity Vitamin D Assess with “ Timed Up and Go Test” or gait speed BMD screening to determine drug treatment Motor vehicle crashes Screen for alcohol misuse; brief counseling with follow-up if positive Domestic violence Be alert for early signs and symptoms Lifestyle-related problems Obesity Discuss Problem with patient; refer obese and physically inactive people to intensive, multidisciplinary programs Physical Inactivity Substance abuse Tobacco 5 A’s*, offer nicotine replacement and bupropion, follow up Alcohol Screen for alcohol misuse; brief counseling with follow up if positive
- 15. ePSS (Electronic Preventive Services Selector) http://epss.ahrq.gov/ePSS/search.jsp
- 16. Immunization
- 17. Immunization
- 18. Patients who should be asked about domestic violence Female trauma victims Female emergency room patients Women with chronic abdominal pain Women with chronic headaches Pregnant women, especially with injuries Women with sexually transmitted diseases Elders with evidence of neglect Elders with injuries