Adult Health Maintenance

00:00 So you know that we’re right in the wheel house of family medicine where we’re talking about adult health maintenance.

00:05 This is something that really falls on us many times to do all of these health maintenance activities and we’ll go over guidelines today that keep your patients well, and these will be some of the questions in terms of when to initiate certain types of testing or screening or preventive medicine and therefore I hope it’s really helpful to you.

00:25 And we’ll start with a case again.

00:27 So I’ve got a healthy 29-year-old woman.

00:30 She’s here for an annual wellness assessment, which is part of the recommendations for health maintenance services for this patient.

00:37 Is it A. Depression screening, B. Chlamydia screening, C. HPV vaccine, or D. Pneumococcal vaccine? The answer is depression screening.

00:49 So as you may recall, depression screening is recommended for adults broadly when the practice has the ability to follow up patients and treat depression appropriately.

01:00 Whereas, chlamydia screening routinely for women stops at age 25, our patient is 29 years old.

01:07 HPV vaccine, again, stops at age 26, our patient is 29 years old, and she’s too young for the pneumococcal vaccine, as well. So what else do we recommend for younger adults in terms of health maintenance? Well, you should have a blood pressure check at least every two years, Cholesterol screening is recommended for men aged 35 years and above and women aged 45 years and above in the absence of risk factors for coronary artery disease.

01:34 For younger people lipid screening is recommended only in the case these factors are present (eg. diabetes mellitus, hypertension).

01:41 The ideal interval to repeat screening is not yet fixed, although a 5-year interval seems reasonable in people with a normal lipid profile.

01:49 A diabetes screen based on anyone with a family history of diabetes, from a racial or ethnic minority group, or with obesity.

01:58 That’s a pretty big group that needs diabetes screening, a lot of times I’ll do that with the cholesterol screening.

02:03 Depression screening, I already mentioned.

02:06 Cervical cancer screening is recommended between ages 21 to 65 years of age.

02:11 Now, with cytology alone, the screening can be done every three years.

02:16 Combined testing with cytology and human papilloma virus testing that’s negative, that can be assigned that the woman only needs every five years for a cycle for her cervical cancer screening.

02:31 HIV testing is recommended for everybody at least once, obviously more frequently among patients with high-risk behaviors, IV drug abuse, sex workers.

02:41 And chlamydia screening, I mentioned, through age 25 among women.

02:46 How about vaccines? Influenza vaccine is recommended essentially for -- It’s very easy now if you remember the vaccine recommendations for influenza from our Centers for Disease Control.

02:59 Everyone who’s at average risk, who is six months or older, should receive annual influenza vaccine -- easy.

03:08 Adults should receive a Tdap vaccine if they have not had one in the past 10 years.

03:12 Following that, adults should be protected against tetanus with the Td vaccine every 10 years.

03:17 As I mentioned, HPV vaccine through age 26.

03:21 So what to add during ages 40 to 49 years? You want to at least consider mammography for women.

03:30 The interval could be every one to two years.

03:32 And we’re going to spend time in an upcoming discussion talking about breast cancer screening specifically.

03:38 But one thing to realize is that the routine self-breast examination done at home is not recommended.

03:44 You can also think about prostate cancer screening for high-risk patients, African-Americans, and those with a family history of prostate cancer.

03:53 We will also be discussing prostate cancer screening as its own topic in another discussion about general cancer screening among adults.

04:01 Now when the patient is 50 years old, mammography should be considered every one to two years until age 75, but you can consider extending that if the patient’s life expectancy is at least 10 years, as many women’s lives are now getting longer and longer.

04:18 Bone mineral density testing with a DEXA test should be initiated at age 65.

04:24 This is relatively new as a guideline, but there is a reservoir of hepatitis C out there that many, many patients did not know that they had and therefore it’s recommended to screen persons between age 1945 and 1965 one time only for hepatitis C.

04:44 According to CDC adults who are immunocompetent and aged 65 years or older should receive the 20-valent pneumococcal conjugate vaccine (PCV20) or PCV15 followed by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) at 12 months later.

05:01 Other vaccines, remember, herpes zoster vaccine at age 60.

05:05 So colorectal cancer, we have a separate discussion on that coming up, but just understand there are multiple modalities that you can use.

05:16 Certainly, in Europe, fecal occult blood test is the preferred method for broad screening for average risk patients for colorectal cancer.

05:25 And it’s worth thinking at least about screening for prostate cancer beginning at age 50, but it remains a controversial area.

05:35 Men age 65-75 who have ever smoked should be checked with an abdominal ultrasound in order to screen for abdominal aortic aneurysm.

05:42 So that’s a really brief tour of health maintenance and preventive care with some of the milestones.

05:49 I think every one of those slides contained material that could well be on the examination and it’s just worth knowing some of those age cutoffs and some of those recommended procedures.

06:00 Hope it was helpful.