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Chuang preventivecaretable-1.docx - UNC School of Medicine

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					                     USPSTF                                           ACOG (April 2011)      Other
Alcohol Misuse       Screen very visit for adults (Apr 2004,          Every visit
(screening           B)…evidence demonstrates screening with
/counseling)         multi-contact counseling reduces number of
                     drinks, increases proportion of patients
                     drinking at safe levels, which has been linked
                     to decreased long-term and short-term
                     health risks from alcohol consumption
                     http://www.ncbi.nlm.nih.gov/books/NBK428
                     63/

Blood pressure in    Screen every visit age 18 and older (Dec         Every visit,
adults (screening)   2007, A)…evidence demonstrates screening         starting age 13
                     can identify patients at increased
                     cardiovascular risk and treatment can
                     decrease cardiac events
Breast Cancer        Dec 2009> Screen with:                           MMG every 1-2          American College
(screening)               Biennial MMG ages 50-74 (, B)              years at age 40,       of Radiology (ACR)
                          MMG before age 50 should be                then annually          and American
                             individualized (C)                       after age 50           Cancer Society
                          MMG after age 75 (I)                                              (ACS)
                          BSE (D)                                                           recommends
                          CBE after age 40 (I)                                              annual
                          Digital MMG or MRI for screening (I)                              mammogram
                                                                                             starting at age 40.
                                                                                             ACR also
                                                                                             recommends
                                                                                             annual CBE over
                                                                                             age 40 and BSE
                                                                                             starting in the
                                                                                             20’s.
Cervical Cancer      Jan 2003:                                        Every 2 years ages     ACS recommends
(screening)               Screen women with cervix and               21-30, then every      starting age 21 or
                            sexually active (A)                       3 years if 3           3 years after onset
                          Screen women over age 65 at low            consecutive            of vaginal
                            risk (D)                                  negative Paps and      intercourse,
                          Screen women with hysterectomy (D)         low risk (no           annual screen
                          Screen with new technologies for           history of CIN 2-3,    with regular Pap
                            screening (I)                             HIV negative, no       or every 2 years
                          Screen with HPV (I)                        DES exposure) or       with liquid based.
                                                                      if Pap and HPV         Other
                                                                      both negative          recommends of
                                                                      …until age 65 or       ACS like ACOG.
                                                                      70 if low risk
Colon Cancer         Oct 2008:                                        Colonoscopy            ACS recommends
                          Screen starting age 50 (FOB, flex sig      every 10 years or      flex sig, BE or CT
                            or colonoscopy) (A)                       flex sig/BE/CT         colonography
                          Screen patients ages 76-85 (C)             colonograhy every      every 5 years or
                          Screen patients older than 85 (D)          5 years, starting at   colonoscopy every
                          Screen with CT or fecal DNA (I)            age 50. FOBT           10 years; they also
                                                                      should be              recommend
                                                                      performed              annual FOBT.
                                                                      annually.              American College
                                                                                               of
                                                                                               Gastroenterology
                                                                                               recommends
                                                                                               colonoscopy
                                                                                               starting at age 45
                                                                                               in African
                                                                                               Americans.
Coronary Heart          Feb 2004                                         Every visit assess
Disease (screening)          Screen with EKG, ETT or electroni          risk factors/family
                               beam CT in low risk patients (D)          history
                             Screen with these modalities in high
                               risk patients (I)
Depression in Adults    Dec 2009                                         Every visit,
(screening)                  Screen with support in place for           starting age 13
                               accurate diagnosis, treatment and
                               followup (B)
                             Screen when these are not available
                               (C)
Diabetes (screening)    Jun 2008                                         Fasting glucose       American
                             Screen in asymptomatic patients with       every 3 years         Diabetes
                               BP 135/80 (g)                             starting age 45       Association (ADA)
                             Screen in asymptomatic patients with                             recommends
                               BP lower than 135/80 (I)                                        screening in
                                                                                               overweight/obese
                                                                                               individuals who
                                                                                               have one or more
                                                                                               risk factors or at
                                                                                               age 45 every 3
                                                                                               years using A1C,
                                                                                               fasting glucose or
                                                                                               2h 75g OGTT>
Diet/nutrition          Jan 2003                                         Every visit,
(counseling)                  Counsel patient re: healthy diet (I)      starting age 13
                              Counsel intensively patient with
                                 hyperlipidemia or other coronary risk
                                 (B)
Drug Use, illicit       Screen for illicit drug use in adults,           Every visit,
(screening)             adolescents and pregnant women (I)               starting age 13
Dyslipidemia            June 2008                                        Lipid profile every   The American
(screening)                   Screen women age 45 and older if at       5 years, starting     Heart Association
                                 increased risk (A)                      age 45                (AHA)
                              Screen women age 20-45 if at                                    recommends
                                 increased risk (B)                                            fasting lipid profile
                              Screen women ages 20 and older                                  every 5 years
                                 NOT at increased risk (C)                                     starting at age 20.
Exercise/Physical       Counsel to promote physical activity (Aug        Every visit,
activity (counseling)   2002, I)                                         starting age 13
HIV (screening)         Jul 2005                                         Every visit,
                              Screen adolescents/adults at              starting age 13, if
                                 increased risk (A)                      sexually active
                              Screen adolescents/adults NOT at
                                 increased risk (C)
Incontinence              No statement                                  Every visit,
(screening)                                                             starting age 19
Motor Vehicle             Aug 2007                                      Every visit,
Occupant Restraints           Counsel re: motor vehicle safety         starting age 13
(counseling)                     restraints (I)
                              Counsel again driving while impaired
                                 or riding with those who are (I)
Obesity                   Dec 2003                                      Every visit,
(screening/counseling)        Screen all patients, follow up obese     starting age 13
                                 patients with intensive
                                 counseling/behavioral intervention
                                 (B)
                              Screen all patients, follow up obese
                                 with moderate counseling/behavioral
                                 intervention (I)
                              Screen all patients, follow up
                                 overweight with any
                                 counseling/behavioral intervention (I)

Osteoporosis              Screen women age 65 or older and younger      Postmenopausal        National
(screening)               women with fracture risk of 65 year old low   women older than      Osteoporosis
                          risk women (Jan 2011, B)                      65 or younger         Foundation
                                                                        with risk factors     recommends
                                                                        (smoking, poor        same as ACOG.
                                                                        nutrition,
                                                                        Caucasian,
                                                                        sedentary, low
                                                                        BMI, hx of adult
                                                                        fracture, fam hx
                                                                        osteoporosis,
                                                                        hypoestrogenic,
                                                                        medical
                                                                        conditions
                                                                        associated with
                                                                        osteoporosis)
Ovarian cancer        Screen routinely (May 2004, D)
(screening)
Reproductive concerns No statement                                      Every visit,
(screening)                                                             particularly after
                                                                        ages 19-64
Sexual Dysfunction        No statement                                  Every visit,
(screening)                                                             starting age 13,
                                                                        focusing more on
                                                                        high risk behaviors
                                                                        and sexual
                                                                        orientation/gende
                                                                        r identity between
                                                                        ages 13-18
Sexually Transmitted      Oct 2008                                      Every visit,
Infections (counseling)        Counsel intensely adolescents/adults    starting age 13
                                 at risk (B)
                               Counsel adolescents/adults not at
                                risk (I)
Skin cancer              Screen with whole-body exam (Feb 2009, I)          Every visit,
(screening)                                                                 starting age 13
Skin Cancer              Counsel patient routinely about skin cancer        Every visit,
(counseling)             prevention (Oct 2003, I)                           starting age 13
Suicide Risk             Screen routinely (May 2004, I)                     Every visit,
(screening)                                                                 starting age 13
Thyroid disease          Screen routinely (Jan 2004, I)                     Every 5 years     American Thyroid
(screening)                                                                 starting age 50   Association
                                                                                              recommends
                                                                                              screening every 5
                                                                                              years starting at
                                                                                              age 35. American
                                                                                              Association of
                                                                                              Clinical
                                                                                              Endocrinologists
                                                                                              recommends all
                                                                                              women be tested
                                                                                              by age 50.
Tobacco Use              Apr 2009                                           Every visit,
(counseling and               Screen all adults and provide tobacco        starting age 13
intervention)                   cessation support/intervention (A)
                              Screen pregnancy women and
                                provide cessation
                                support/intervention tailored to
                                pregnancy (A)


USPSTF Grades
A: substantial benefit, perform
B: moderate benefit, perform
C: moderate certainty that net benefit is small, do not routinely perform
D: moderate to high certainty no net benefit, do not perform
I: insufficient evidence, unknown
Vaccinations

Vaccination     Standard frequency       High risk description                           Pregnancy
Dtap            Once ages 11-18, once    adults with anticipated close contact with      Not the pertussis part, but
                age 19-39 then q 10      infants less than 12 months of age including    could get Td if sustain cut and
                years,                   women anticipating pregnancy; health care       need tetanus booster.
                                         providers
Hep B           One series for those     Hemodialysis, possible occupational             If at risk
                not vaccinated under     exposure, health care workers and public
                age 18                   safety workers, drug abuse, clients/staff of
                                         institutions that care for developmentally
                                         disabled. high risk sexual behaviors,
                                         household contacts and sexual partners of
                                         those with chronic HBV; travel to countries
                                         with endemicity; inmates
HPV             Ages 9-26                                                                No
Influenza       annually                                                                 Yes, but NOT nasal spray
MMR             Standard childhood              Adults born 1957 or later: offered      No
                doses                            one if no documentation
                                              Adults vaccinated 1963-67: offered
                                                 revaccination (2 doses)
                                              Health care workers, students,
                                                 rubella non-immune, college
                                                 students
Meningococcal Once prior to high         College students in dorms, occupational         If at risk
              school if not previously   exposure to Neisseria meningitides, travel to
              immunized                  areas with endemicity; asplenia or terminal
                                         complement deficiency
Varicella       One series for those                                                     No
                without evidence of
                immunity
Hep A                                    chronic liver dz, illegal drug use, working     Data unclear
                                         with HAV in primates or research lab,
                                         traveling to area of endemicity
Pneumococcal                             Chronic illness, exposure to outbreak of        If at risk
                                         pneumococcus, immunocompromised,
                                         alcoholism…may need revaccination

				
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