Transcript Female preventative exam - Indiana Osteopathic Association

Stephanie Overmars, D.O.
IOA 117th Annual Convention
May 4, 2014
 Health
maintenance examination is an
opportunity to focus on disease prevention
 No
consensus on the optimal frequency
 Chance
for physicians to strengthen their
relationship with patients
 Recommendations
for this presentation come
primarily from the United States Preventive
Services Task Force (USPSTF) and are
supported by the American Academy of
Family Physicians (AAFP).
 “Today
we will be addressing issues that are
important for preventative care. I am proud
that you are taking the step to be on top of
health promotion. Unfortunately, this may
not include all of your chronic illness
concerns. If we run out of time today, we
may need to schedule a follow up
appointment.”
 Medical
 Allergies
 Medications
 Surgeries
 Specialists
 Social
 Family
History

18.1% of US adults over
18 years of age smoke
cigarettes.

Cigarette smoking is the
leading cause of
preventable death in the
US.

More than 16 million
Americans suffer from a
disease caused by
smoking.

Assess readiness to quit.

C – Have you ever felt like
you should cut down on your
drinking?

A – Have people annoyed you
by criticizing your drinking?

G – Have you ever felt bad or
guilty about your drinking?

E – Have you ever had a drink
first thing in the morning
(eye opener) to steady your
nerves or to get rid of a
hangover?
 If
you drink alcohol, drink no more than one
drink per day. One drink is counted as:

The USPTF has
provisionally
recommended that
women of
childbearing age be
screened for potential
partner violence.

Women who screen
positive should be
referred to
intervention services.

PHQ2 (Patient Health Questionnaire 2): Inquires
about the frequency of depressed mood over the
past 2 weeks
Over the past 2 weeks, how often have you been
bothered by any of the following problems?
1. Little interest or pleasure in doing things
 2. Feeling down, depressed, or hopeless


Individuals rate “not at all” (0) to “nearly every
day: (3). Score of > 2, recommend filling out
PHQ9.

A PHQ 9 score of > 10 has increased probability
of being diagnosed as depressed.

Premenopausal women
should be screened about
reproductive plans.

In those patients not
wishing to get pregnant –
discuss contraception.

In those patients wishing
to get pregnant – discuss
supplementation with folic
acid, prenatal vitamins,
and other appropriate
counseling measures.

USPSTF recommends high risk
women be screened at least
annually for chlamydia,
gonorrhea, and syphilis.

USPSTF recommends sexually
active women age 24 years
and younger be screened
annually for chlamydia.

USPSTF and CDC recommend
screening all adolescents and
adults through 65 years of
age for HIV.
 Heart
disease is
the #1 cause of
death in women in
the US.
 Routinely




screen
Blood pressure
Weight
Cholesterol
Glucose
Systolic
(mmHg)
Diastolic
(mmHg)
Normal
< 120
< 80
Pre-HTN
120-139
80-89
HTN
> 140
> 90
*In the general population younger than age 60
 Elevated
body mass
index (BMI) is a
marker of unhealthy
weight. BMI is
measured by taking
into account a
patient’s weight and
height; BMI is
measured in kg/m2.
Underweight: BMI < 18.5
 Normal weight: BMI 18.524.9
 Overweight: BMI 25-29.9
 Obesity: BMI > 30

 Measured
with a
nondistensible tape
measure placed
around the
abdomen at the
umbilicus parallel to
the floor with the
patient standing.
 Goal

Women < 35 inches
 Cholesterol
Women 20 years and
older if increased risk
 Screen every 1-5
years

 Glucose
All women beginning
at age 45
 All overweight women
with risk factors
 Asymptomatic adults
with elevated blood
pressure

 Other
 USPSTF
recommends that
women 55 to 79
years of age take
at least 75mg of
aspirin per day
when the benefit
of stroke
prevention
outweighs the risk
of GI hemorrhage.
 Most
women older
than 18 years of
age need 7-9 hours
of sleep a night.

AHA recommends at
least 30 minutes of
moderate intensity
aerobic activity at least
5 days a week.

AHA recommends at
least 25 minutes of
vigorous aerobic
activity 3 days per week
and moderate to high
intensity muscle
strengthening activity 2
days per week.

Nearly ½ of adults age
30 and older have a
form of chronic
inflammatory gum
disease that can
ultimately lead to tooth
loss.

Prevention of gum
inflammation reduces
tooth loss, but there is
little evidence to
support a twice yearly
visit to the dentist for
everyone.

USPSTF concludes that
that current evidence is
insufficient to assess
the balance of benefits
and harms of screening
for visual acuity for the
improvement of
outcomes in older
adults.

AAO Recommends*:
Age
 Age
 Age
 Age

< 40 – every 5-10 yrs
40-54 – every 2-4 yrs
55-64 – every 1-3 yrs
> 65 – every 1-2 yrs
*Adults with No Risk Factors
 The
USPSTF and
AAFP recommend
routine biennial
screening
beginning at 50
years of age with
discontinuation at
75 years of age.
 The
ACOG and ACS
recommend annual
screening
beginning at age
40 without a
specific
discontinuation
age.
 Adults
50 to 75
years of age
should undergo
screening
FOBT (annually)
 Sigmoidoscopy
(every 5 years) plus
FOBT (every 3
years)
 Colonoscopy (every
10 years)

 DEXA
is routinely recommended for women
65 years of age and older.
 Screening
women younger than 65 years of
age should be based on risk assessment.

Start screening at age
21

Low risk: Screen
every 3 years

Co-testing for HPV is
an option at age 30

Discontinue screening
at age 65, or after
hysterectomy due to
benign pathology

Influenza – 1 dose annually (ages 19+)

Adults aged 65 years or older can receive the standard dose or
the high dose (Fluzone)

Tdap – substitute 1 time dose of Tdap for Td booster; then
boost with Td every 10 years (ages 19+)

Varicella – 2 doses (ages 19+)
All adults without evidence of immunity to varicella.
 Doses must be at least 4 weeks apart.
 Do not give during pregnancy.


HPV – 3 doses (ages 19-26)
Second dose given 4-8 weeks after the first dose
 Third dose given 24 weeks after the first dose and at least 16
weeks after the second dose (minimum interval of 12 weeks).
 Do not given during pregnancy


Zoster – 1 dose (ages 60+)


May given immunization whether there is a prior episode
of herpes zoster or not
Pneumonia – 1 dose (ages 65+)




May give dose for < 64 years of age if chronic condition
criteria is met.
One time revaccination 5 years after the first dose is
recommended for 19-64 years of age with chronic renal
failure, function or anatomic asplenia, or
immunocompromising conditions
Persons who received 1 or 2 doses before age 65 years
for any indication should receive another dose of the
vaccine at age 65 if at least 5 years have passed since
their previous dose
No further doses are needed for persons vaccinated after
age 65 years
 Consider
other immunizations if criteria are
met:



Meningococcal – 1 or more doses (ages 19+)
Hepatitis A – 2 doses
Hepatitis B – 3 doses
 Was
there anything
at your visit today
that we did not
discuss that you
feel is important?

“Ages 40-64 Years: Exams and Screening Tests.” ACOG. http://www.acog.org. Accessed April 7,
2014.

“Ages 65 years and older: Exams and Screening Tests.” ACOG. http:/www.acog.org. Accessed April
7, 2014.

American Academy of Family Physicians. Obesity – Clinical Recommendations. June 2013.
http://s.aafp.org/?q=obesity+clinical+recommendations&q1=&x1=&first_serach=0&search=Entire+
Site. Accessed April 15, 2014.

American Heart Association. Recommendation for Physical Activity in Adults.
http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/American-Heart-AssociationRecommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp. Accessed April 15,
2014.

American Psychological Association. Patient Health Questionnaires (PHQ-9 & PHQ-2).
http://www.apa.org. Accessed April 14, 2014.

Borgmeyer C. “2014 Hypertension Guidelines Stands to Simplify Treatment, Says Expert.” AAFP
News. Dec 18, 2013.

Center for Disease Control. Adult Cigarette Smoking in the United States: Current Estimates.
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/. Accessed
April 14, 2014.

Comprehensive Adult Medical Eye Examination. 2010. http://oneaao.org/preferred-practicepattern/comprehensive-adult-medical-eye-evaluation--octobe. Accessed April 22, 2014.

Deen, D. Metabolic Syndrome: Time for Action. Amer Fam Phys. 2004; 69(12):2875-2882.

National Cholesterol Education Program. Third Report of the National Cholesterol Education
Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
(Adult Treatment Panel III) final report. www.nhlbi.nih.gov/guidelines/cholestrol/atp3. Accessed
April 15, 2014.

National Institute on Alcohol Abuse and Alcoholism. CAGE Questionnaire. February 2002.
http://pubs.niaaa.nih.gov/publications/inscage.htm

National Sleep Foundation. How Much Sleep Do We Really Need? http://sleepfoundation.org/howsleep-works/how-much-sleep-do-we-really-need. Accessed April 15, 2014.

Recommended Adult Immunization Schedule- United States 2014. Center for Disease Control and
Prevention.

Riley M, et al. Health Maintenance in Women. Amer Fam Phys 2013; 87(1):30-37.

Saint Louis, C. Rethinking the Twice-Yearly Dentist Visit. New York Times. June 10, 2013.

Screening for cervical cancer. Obstet Gnecol. 2012; 120(5): 1222-1238.

U.S. Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease. October
2013. http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm. Accessed April 15,
2014.

U.S. Preventive Services Task Force. Screening Behavioral Counseling Interventions in Primary Care
to Reduce Alcohol Misuse. May 2013.
http://www.uspreventiveservicestaskforce.org/uspstf/uspsdrin.htm. Accessed April 15, 2014.

U.S. Preventive Services Task Force. Screening for Breast Cancer. December 2013.
http://www.uspreventiveservicestaskforce.org/breastcancer.htm. Accessed April 15, 2014.

U.S. Preventive Services Task Force. Screening for Chlamydial Infection. June 2013.
http://www.uspreventiveservicestaskforce.org/uspstf/uspschlm.htm. Accessed April 15, 2014.

U.S. Preventive Services Task Force. Screening for Colorectal Cancer. April 2014.
http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm. Accessed April 20, 2014.

U.S. Preventive Services Task Force. Screening for Gonorrhea. June 2013.
http://www.uspreventiveservicestaskforce.org/uspstf/uspsgono.htm. Accessed April 15, 2014.

U.S. Preventive Services Task Force. Screening for HIV. April 2013.
http://www.uspreventiveservicestaskforce.org/uspstf/uspshivi.htm. Accessed April 15, 2014.

U.S. Preventive Services Task Force. Screening for Impaired Visual Acuity in Older Adults. April
2014. http://www.uspreventiveservicestaskforce.org/uspstf/uspsviseld.htm. Accessed April 22,
2014.

U.S. Preventive Services Task Force. Screening for Osteoporosis. March 2011.
http://www.uspreventiveservicestaskforce.org/uspstf/uspstf.htm. Accessed April 20, 2014.

U.S. Preventive Services Task Force. Screening for Syphilis Infection. July 2004.
http://www.uspreventiveservicestaskforce.org/uspstf/uspssyph.htm. Accessed April 15, 2014.

Women’s Health. A Lifetime of Good Health: Your Guide to Staying Healthy. February 2011.
https://www.womenshealth.gov/publications/our-publications/a-z-list.html#a. Accessed April 13,
2014.