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health maintenance (preventive medicine)

Epidemiology: - 50% of adults (USA) receive clinical preventive services [2] Management: 1) screening - screening for hypertension* (blood pressure) all adults - screening for excessive salt consumption* ? [7] - screening for obesity* (height & weight) all adults - screening for alcohol abuse* (all adults) - screening for tobacco abuse* - screening for depression (appropriate follow-up available) - screening for diabetes mellitus type 2* (patients with hypertension, obesity) - screening for dyslipidemia (men >= 35; women >= 45) - screening for colorectal cancer (age 45-75) - screening for breast cancer (women 50-74 years (40-49 if genetic risk, breast implantation or patient preference) - screening for cervical cancer (women 21-65) - screening for Chlamydia trachomatis (sexually active women < 25 years; other high-risk women) - HIV1 screening (age 13-64; 15-65 USPSTF; all persons at risk) - CDC & USPSTF recommend screening for hepatitis C all adults 18-79 years at least once [1] - screening for osteoporosis (bone mineral density) women > 64 years; at risk women > 59 years - screening for urinary incontinence recommended annually at preventive health visits for all women of all ages [14] - screening for abdominal aortic aneurysm (AAA) men 65-75 years - see prenatal care for screening of pregnant women 2) screening not recommended (USPSTF) [1] - hemochromatosis - coronary artery disease - herpes simplex virus - several common cancers (see screening for cancer) 3) counseling - tobacco cessation - alcohol abuse - brief office behavioral counseling - referral for specialty treatment - diet & exercise - behavioral dietary counseling for patients with dyslipidemia, cardiovascular risk factors, & other diet - exercise 30 minutes per day most days of the week - intensive counseling/behavioral interventions for obese patients - salt consumption ? [7] - treat unhealthy behaviors such as smoking, poor diet, & lack of exercise as aggressively as hypercholesterolemia, hypertension, & cardiovascular risk factors [5] * 6 risk factors if controlled could lead to 20% reduction in premature mortality [7] Notes: - wellness visits aimed at the general population are not supported by evidence [1,3] - screening has no effect on morbidity, hospital admission, disability, subsequent physician visits, number of specialist referrals, or work absences - health-checks do, however, result in a higher number of new diagnoses [3] - patients tend to overestimate benefits of preventive screenings [4] - implementing USPSTF recommended preventive services across a 2500 adult patient panel would require 8.6 hours per working day [15] - 1/3 of U.S. adults does not receive recommended preventive care, regardless of insurance status or income [8] - a purpose in life from early adulthood improves longevity & increases compliance with health services [10] - purpose in life is associated with a faster walking speed in older adults 4 years later [12]

Related

health health maintenance organization (HMO)

Specific

health maintenance (preventive medicine) in the elderly health maintenance for infants & children health maintenance in nursing home patients screening

General

clinical process

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
  2. Centers for Disease Control and Prevention Use of Selected Clinical Preventive Services Among Adults: United States, 2007-2010 MMWR Supplements: June 15, 2012; Vol 61, Supplement: 1-84 http://www.cdc.gov/mmwr/preview/ind2012_su.html http://www.cdc.gov/mmwr/preview/mmwrhtml/su6102a1.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/su6102a12.htm
  3. The NNT: Routine Health Checks for Reducing Mortality and Morbidity http://www.thennt.com/nnt/routine-health-checks-for-reducing-mortality-and-morbidity/ - Krogsboll LT et al General health checks in adults for reducing morbidity and mortality from disease The Cochrane Library. 17 OCT 2012 PMID: 23076952 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009009.pub2/abstract - Krogsboll LT et al General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis PMID: 23169868 BMJ 2012;345:e7191 http://www.bmj.com/content/345/bmj.e7191
  4. Hudson B et al Patients' Expectations of Screening and Preventive Treatments. Ann Fam Med. 2012 vol. 10 no. 6 495-502 PMID: 23149525 http://www.annfammed.org/content/10/6/495.full
  5. Spring B et al Better Population Health Through Behavior Change in Adults. A call to action. Circulation. October 7, 2013 PMID: 24100544 http://circ.ahajournals.org/content/early/2013/10/07/01.cir.0000435173.25936.e1.full.pdf+html
  6. Lin JS, O'Connor E, Whitlock EP, Beil TL Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010 Dec 7;153(11):736-50 PMID: 21135297
  7. Kontis V et al Contribution of six risk factors to achieving the 25x25 non-communicable disease mortality reduction target: a modelling study. The Lancet, Early Online Publication, 3 May 2014 PMID: 24797573 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960616-4/abstract - Atun R Decisive action to end apathy and achieve 25x25 NCD targets. The Lancet, Early Online Publication, 3 May 2014 PMID: 24797574 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960728-5/fulltext
  8. Fox JB and Shaw FE Relationship of Income and Health Care Coverage to Receipt of Recommended Clinical Preventive Services by Adults. MMWR Weekly. August 8, 2014 / 63(31);666-670 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6331a2.htm
  9. U.S. Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services, 2014. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/
  10. Hill PL, Turiano NA. Purpose in life as a predictor of mortality across adulthood. Psychol Sci 2014 May 8 PMID: 24815612 http://pss.sagepub.com/content/25/7/1482 - Kim ES et al. Purpose in life and use of preventive health care services. Proc Natl Acad Sci U S A 2014 Nov 18; 111:16331 PMID: 25368165 http://www.pnas.org/content/111/46/16331
  11. Oboler SK, LaForce FM. The periodic physical examination in asymptomatic adults. Ann Intern Med. 1989 Feb 1;110(3):214-26. Review. PMID: 2643379
  12. Kim ES, Kawachi I, Chen Y, Kubzansky LD. Association between purpose in life and objective measures of physical function in older adults. JAMA Psychiatry 2017 Aug 16 PMID: 28813554 http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2648692
  13. Pryor K, Volpp K. Perspective. Deployment of Preventive Interventions - Time for a Paradigm Shift. N Engl J Med 2018; 378:1761-1763. May 10, 2018 PMID: 29742382 https://www.nejm.org/doi/full/10.1056/NEJMp1716272
  14. O'Reilly N, Nelson HD, Conry JM et al Screening for Urinary Incontinence in Women: A Recommendation From the Women's Preventive Services Initiative. Ann Intern Med. Aug 14, 2018. PMID: 30105360 http://annals.org/aim/fullarticle/2697085/screening-urinary-incontinence-women-recommendation-from-women-s-preventive-services - Nelson HD, Cantor A, Pappas M, Miller L. Screening for Urinary Incontinence in Women: A Systematic Review for the Women's Preventive Services Initiative. Ann Intern Med. Aug 14, 2018. PMID: 30105353 http://annals.org/aim/article-abstract/2697084/screening-urinary-incontinence-women-systematic-review-women-s-preventive-services - Bell RJ, Davis SR. Routine Screening for Urinary Incontinence in Women: Caution Advised. Ann Intern Med. Aug 14, 2018. PMID: 30105377 http://annals.org/aim/article-abstract/2697086/routine-screening-urinary-incontinence-women-caution-advised
  15. Privett N, Guerrier S Estimation of the Time Needed to Deliver the 2020 USPSTF Preventive Care Recommendations in Primary Care. Am J Public Health. 2020;111(1):145-149 PMID: 33211585 PMCID: PMC7750618 (available on 2023-01-01) https://www.medscape.com/viewarticle/943772