Approach to Health Maintenance & Counseling Flashcards
What is included in a history when a pt comes in for a well visit?
get a thorough history (PMH, PSH, meds, allergies)
include FEDTACOS (w/ extensive SH & FH, sex history)
evaluate risk factors based on lifestyle/family history
What are USPSTF recommendations?
recommendations of clinical preventive services put together by independent panel of experts who volunteer to help make evidence based recommendations
To who do recommendations apply?
to people who do not have signs or symptoms of the specific disease/medical condition
What is the gold standard for evidence based medicine?
systematic reviews (take different trials for stat analysis to use for larger population)
What is the purpose of EBM?
allows pts to have best outcomes b/c provides pts w/ most effective care based on best evidence
helps physicians use good evidence thru published data of outcomes
What are the 4 categories of preventive services?
screening
immunizations
general health guidance
counseling to reduce risk
Primary prevention
intervention to prevent disease
vaccines, diet counseling, tobacco counseling
Secondary prevention
screening test for disease early while pt may still be asymptomatic or before onset of disease
BP checks, labs, mammogram
Tertiary prevention
clinical intervention that prevents disease progression or reduce complications assoc w/ disease
medications for HTN/DM, chemotherapy, diet & counseling still beneficial
What are the highest priority of USPSTF guidelines?
grades A & B (what always want to follow & offer/provide service)
What is an example of a grade C service?
prostate screening if increased risk
When is distinction in prevention techniques blurred?
can counsel to avoid disease & also prevent complications associated w/ a disease
What is the purpose of a well visit?
used to treat current medical conditions & provide appropriate preventive care in effort to decrease health deterioration in future
What do you base prevention services on?
age
gender
risk factor (if entire general pop is @ risk)
What are some harms of screening that should be considered?
cost to pt
anxiety (will screen test cause pt more anxiety)
decrease benefit as pt ages or if pt has other comorbid conditions
What are clinical rules of thumb for checkups?
every 3 years for <49yo adults w/o chronic issues
every 1 year for >50yo w/o chronic issues (yearly labs)
What are best practices for checkups for pts w/ chronic medical problems?
need follows up based on disease
pts w/ diabetes need A1C every 3 months to monitor & adjust meds
pts w/ HTN need followup every 3-6months depending on control to monitory for BP control
General rules for cancer screenings in female
Colon cancer (ages 50-75) Lung Cancer (CT from 55-74yo if 30yr pack history) Cervical cancer (pap smear from 21-65yo) Breast Cancer (mammogram from 50-60yo)
General rules for cancer screenings in males
Colon cancer (ages 50-75) Lung cancer (CT for ages 55-74 w/ at least 30 pack year history of smoking)
General rule for CVS risk assessment
history is essential for screening
pts aged>20yo should undergo CVS risk assessment every 3 to 5 years (more frequently if pt has risk factors)
What do you screen for in CVS risk assessment?
diet smoking physical activity HTN dsyplipidemia DM obesity
Immunization guidelines for adults
flu vax for everyone Td/Tdap every 10 yrs HPV up to age 26 Zoster vax for >50yo Pneumococcal vax for all >65yo Hep B vax for all >65yo & w/ diabetes (& if @ increases risk)
What is important to counseling?
motivational interviewing to see if patient is ready to change
What are important parts of MI?
Open questions
Affirmations
Reflections (so pt knows you are listening)
Summaries
What does counseling on tobacco use show?
counseling on tobacco use has shown dose response in pts (change in behavior w/ counseling & therapy)
What is important in nutrition & exercise counseling?
take inventory of nutrition & exercise/activity
discuss what patient is willing & able to do-start w/ small changes w/ short term goals for each visit
How do small steps in counseling help pt?
small steps for a longer time will most likely lead to bigger impact on pt’s behavioral change
