Health Maintenance


Health Maintenance recommendations as per the USPSTF and the ADA:

 Age Disease Test Repeat Notes
 18 HTN BP QY 
 18 Obesity BMI QY 
 20 HLD Lipids QY age 20 if at risk, yearly if elevated, Q3-5Y if normal
 21 Cervical Ca Pap/HPV Q2-3Y 
 <24 Chlamydia PCR QY < 24 and sexually active
 35 HLD Lipids Q3-5Y Men start at 35, if elevated retest annually.
 40 Breast CA Mammo Q2Y 
 45 DM BGL Q3Y < 45 if obese or BP elevated
 45 HLD Lipids Q3-5Y Women start at 45, if elevated retest annually.
 50+ Colon Ca See * See * < 50 if familial risk factors
 65+ Osteoporosis DEXA 1X < 65 if at risk
     

*Colon Cancer 1 of:
1. Screening Colonoscopy, start at 50+, Q10Y
2. High Sensitivity Stool Occult Blood Testing, start at 50+, Yearly
3. Flexible Sigmoidoscopy, start at 50+, Q5Y

Immunizations:
6+ months, Influenza (Flu), QY
11-12, Meningococcal (Meningitis), booster at 16
11-26, HPV (men & women), 3-dose series
All adults, DTaP, Q10Y
60+, VZ (Shingles), 1X
65+ Pneumococcal (PNA), repeat in 5 Yr, start younger if chronically ill
Hepatitis A, give to those traveling to other countries and those w/ chronic liver disease, give 2 doses.
Hepatitis B, adults at risk, give 3 doses

Health Maintenance in Women: http://www.aafp.org/afp/2013/0101/p30.html

- A 23 yo sexually active F should be screened for chlamydia. 
- A 50 yo F should be screened for breast, cervical and colorectal CA.
- USPSTF - screen for hearing loss via questionnaire, finger rub test, whispered voice test or watch tick.

Clean this up:
Screen:
1. tobacco use
2. alcohol misuse
3. intimate partner violence
3. depression
4. HIV - all women.
5. Obesity
6. HTN 
7. DMII - BP > 135/80 mm 

Premenopausal women - preconception counseling & contraception.
All women - planning or capable of pregnancy -  400 to 800 mcg of folic acid QD.
High-risk sex screen - chlamydia, gonorrhea, and syphilis. 
Women 20 yo / older screen - dyslipidemia if at increased risk of CAD.
Women 55 to 79 - take 75 mg ASA if benefits of stroke reduction outweigh risk of GIB. 
Pap screening - 21 yo,  if results have been NL stop at 65 yo or p hysterectomy.
Mammogram - 40 to 49 years of age based on patients' values, and potential benefits and harms. Mammogram - biennially in women 50 to 74 years of age. 
Screen - colorectal CA 50 to 75 years of age. 
Osteoporosis screen - 65 yo & older & in younger women with a similar risk of fx.
Immunizations according to - Centers for Disease Control and Prevention.
TOOLS: CAGE questionnaire and AUDIT-C 
Vaccinations: http://www.cdc.gov/vaccines/schedules/easy-to-read/adult.html
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