Preventative Med V Flashcards
US Preventative Services Task Force
- Makes evidence based recommendations about clinical preventive services. Ex. Screening
- Volunteer, panel of national experts in prevention & EBM
With regards to the wellness exam & screening, per ACA…
USPSTF A/B recommendations are 100% covered
How are screening decisions made?
- Burden of suffering (the Ds)
- Death, disease, disability, discomfort, dissatisfaction, destitution - Screening test
- Prevention
Harms of screening
- Risks
- Anxiety
- Additional dx testing
- Over-dx
Cardiovascular disease is associated w/ what?
- HTN
- Hyperlipidemia
- CHD
- Carotid artery stenosis
- Abdominal aortic aneurysm
- Peripheral artery disease
- Aspirin prophylaxis
USPSTF recommendations for HTN screening
- 18-39yo = every 3-5 yrs
- ≥ 40 y/o or at increased risk = annual screening
Who are at an increased risk for HTN?
- High-normal BP
- Overweight
- African American
Screening for HTN in children/adolescents according to AAP
≥ 3 y/o = every health care episode
Screening for HTN in children/adolescents according to NHLB
3-17 yo = annually
Screening for HTN in children/adolescents according to AHA (Bright Futures)
During annual well child visits beginning at age 3
USPSTF recommendations for hyperlipidemia screening
- <20, insufficient evidence
- Primary prevention:
1. Age 40-75, no hx CVD, ≥ 1 CVD risk factor, & 10 yr CVD risk ≥ 10% = low-mod dose statin (Grade B) - If CVD risk 7.5-10%, Grade C
- Age 76+, no hx CVD = Insufficient evidence
CHD USPSTF recommendations
- No hx CHD, using non-traditional risk factors: Insufficient evidence
- Using EKG: Low risk adults = Grade D, intermediate/high risk = insufficient evidence
Carotid artery stenosis USPSTF recommendations
- Grade D, bc only 10% of ischemic strokes are caused by CAS
- 1% asymptomatic
- No overall benefit of CEA, stenting, or medical therapy
- Limited by low prevalence & harms
AAA according to USPSTF (men)
- 65-75 yo previous smoker = Grade B
- 65-75 yo never smoker = Grade C
AAA according to USPSTF (women)
- 65-75 yo previous smoker = insufficient evidence
- 65-75 yo never smoker: screening not recommended = Grade D
USPSTF guidelines for aspirin prophylaxis
- Use to prevent CVD & colorectal cancer
- 50-59 yo = Grade B if:
1. ≥ 10% 10-year CVD risk,
2. Not at risk of bleeding
3. Have a life expectancy of at least 10 yrs
4. Willing to take low-dose aspirin daily for at least 10 yrs - 60-69 y/o with a ≥ 10% 10-yr CVD risk = Grade C:
1. More likely to benefit if not at increased risk of bleeding, life expectancy is at least 10 yrs, willing to take low-dose aspirin daily for at least 10 yrs - Adults < 50 y/o & ≥ 70 y/o = insufficient evidence
Colorectal cancer according to USPSTF
- Grade A = adults age 50-75 yo
- Grade C = adults age 76-85
- Most appropriate if healthy enough to undergo tx, & no comorbid conditions limiting life expectancy
- Greater benefit if never been screened
Prostate cancer according to USPSTF (benefits)
Grade D
- Large US study = no benefit
- Large European study = no more than 1:1000 avoid death by screening
Prostate cancer according to USPSTF (harms)
- False positives
- Biopsy side effects
- Overtx
- Side effects from tx
Skin cancer according to USPSTF
Insufficient evidence
Breast cancer according to USPSTF
- Age 40-49, individualize = Grade C
- Every 2 yrs age 50-74 = Grade B
Breast cancer according to ACOG
- Every year, age 40-74
- ≥ age 75, individualize
Lung cancer according to USPSTF
- Grade B: Adults aged 55-80 w/ a hx of smoking
1. Annual screening w/ low-dose CT if there is a 30-pack-yr smoking hx & pt currently smokes or has quit within the past 15 yrs
2. Discontinue screening once pt has not smoked for 15 years, or develops a health problem substantially limiting life expectancy or the willingness to have curative lung surgery
Chlamydia & gonnorhea recommendations
- Grade B: screen in sexually active women ≤ 24 y/o & older women at increased risk
- Insufficient evidence for men
Hep B recommendations
- Grade B: Those at high risk
- Grade A: Screen pregnant women at 1st prenatal visit
Hep C recommendations
- Grade B: Those at high risk & offer 1-time screening to adults born btwn 1945 & 1965
- Screening adolescents & adults *
HIV recommendations
- Adolescents & adults aged 15-65
- Those younger or older if at increased risk
- All pregnant women (grade A) *
- Non-pregnant adolescents & adults *
- Pre-exposure prophylaxis *
Syphilis recommendations
- Grade A: Asymptomatic, non-pregnant adults & adolescents at increased risk
- Grade A: All pregnant women
Thyroid disorder recommendations
Insufficient evidence
Thyroid cancer recommendations
Grade D
Osteoporosis recommendations
- Grade B: women ≥ 65 y/o & younger women whose fx risk is equal to or greater than that of a 65 y/o white woman who has no additional risk factors
- Insufficient evidence for men
CVD- Peripheral artery disease USPSTF recommendations
Risk assessment w/ ankle brachial index = insufficient evidence
Cervical cancer USPSTF recommendations
- Women 21-65 (pap) every 3 yrs OR
- Women 30-65 (in combo w/ HPV testing) every 5 yrs
Cervical cancer USPSTF DRAFT
Women 21-65:
- Every 3 yrs for cytology in ages 21-29
- Every 3 yrs for cytology alone in ages 30-65 OR
Every 5 yrs w/ HPV testing alone
Cancer: Access hereditary risk
- Need for genetic counselor
- Tumor markers
Cancer: Address preventative factors
- Avoid tobacco
- Physical activity
- Healthy weight
- Diet rich in fruits, vegetables, whole grains, & low in saturated/trans fat
- Limit alcohol consumption
- Protect against STIs
- Avoid excess sun
Psychosocial health concerns
- Depression
- Substance related problems
- Intimate partner violence
Depression recommendations
- Grade B: screen adults, including pregnant & postpartum women
- Grade B: screen for major depressive disorder in adolescents 12-18 y/o
- Children ≤ 11 y/o: Insufficient
Screening tools for depression
- Patient Health Questionnaire (PHQ)-2
- PHQ-9
- Beck Depression Inventory for Primary Care
- 5-Item World Health Organization Well-Being Index (WHO-5)
Tobacco recommendations
- Grade A: ask all adults about tobacco use, advise them to stop using tobacco, & provide behavioral interventions
- In non-pregnant adults provide U.S. Food & Drug Administration (FDA)–approved pharmacotherapy for cessation to adults who use tobacco
Tobacco use in children/adolescents recommendations
- Grade B: provide interventions (education or brief counseling) to prevent initiation of tobacco use
Alcohol recommendations
- Grade B: screen adults ≥ 18 y/o for alcohol misuse & provide pts engaged in risky or hazardous drinking w/ brief behavioral counseling interventions to reduce alcohol misuse
- < 18 y/o: Insufficient evidence
Drug use recommendations
- Screening* adolescents, adults, pregnant women: insufficient
- Children, adolescents not already dx w/ substance use disorder: insufficient
Intimate partner violence recommendations
- Women of childbearing age: Grade B: screen & provide/refer women who screen positive to intervention services
- Elderly or vulnerable adults: Insufficient
Obesity recommendations
- Grade B: screen all adults; offer/refer pts w/ BMI of 30 kg/m2or higher to intensive, multicomponent behavioral interventions
- Grade B: screen children & adolescents ≥ 6 y/o; offer/ refer to comprehensive, intensive behavioral interventions to promote improvements in weight status
- Weight Loss to Prevent Obesity-Related Morbidity & Mortality in Adults: Behavioral & Pharmacotherapy Interventions
Vision recommendations
- Insufficient evidence for glaucoma
- Insufficient evidence for impaired visual acuity in adults 65+
- Grade B: vision screening at least once in children aged 3-5 y/o for amblyopia or its risk factors
Hearing recommendations
Insufficient evidence for hearing loss in asymptomatic adults 50+
Falls/fx risk recommendations
- Community-dwelling older adults age 65 or older at increased risk for falls
- Exercise = Grade B
