health maintenance (preventive medicine)
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Epidemiology
- 50% of adults (USA) receive clinical preventive services[2]
Management
- 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
- screening for hypertension* (blood pressure) all adults
- screening not recommended (USPSTF)[1]
- hemochromatosis
- coronary artery disease
- herpes simplex virus
- several common cancers (see screening for cancer)
- 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]
More general terms
More specific terms
- health maintenance (preventive medicine) in the elderly
- health maintenance for infants & children
- health maintenance in nursing home patients
- screening
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2022.
- ↑ 2.0 2.1 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
- ↑ 3.0 3.1 3.2 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23076952 <Internet> 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: https://www.ncbi.nlm.nih.gov/pubmed/23169868 BMJ 2012;345:e7191 http://www.bmj.com/content/345/bmj.e7191 - ↑ 4.0 4.1 Hudson B et al Patients' Expectations of Screening and Preventive Treatments. Ann Fam Med. 2012 vol. 10 no. 6 495-502 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23149525 <Internet> http://www.annfammed.org/content/10/6/495.full
- ↑ 5.0 5.1 Spring B et al Better Population Health Through Behavior Change in Adults. A call to action. Circulation. October 7, 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24100544 <Internet> http://circ.ahajournals.org/content/early/2013/10/07/01.cir.0000435173.25936.e1.full.pdf+html
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/21135297
- ↑ 7.0 7.1 7.2 7.3 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24797573 <Internet> 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24797574 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2960728-5/fulltext - ↑ 8.0 8.1 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
- ↑ U.S. Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services, 2014. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/
- ↑ 10.0 10.1 Hill PL, Turiano NA. Purpose in life as a predictor of mortality across adulthood. Psychol Sci 2014 May 8 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24815612 <Internet> 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25368165 <Internet> http://www.pnas.org/content/111/46/16331 - ↑ Oboler SK, LaForce FM. The periodic physical examination in asymptomatic adults. Ann Intern Med. 1989 Feb 1;110(3):214-26. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/2643379
- ↑ 12.0 12.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28813554 <Internet> http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2648692
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/29742382 https://www.nejm.org/doi/full/10.1056/NEJMp1716272
- ↑ 14.0 14.1 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. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30105360 <Internet> 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. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30105353 <Internet> 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. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/30105377 <Internet> http://annals.org/aim/article-abstract/2697086/routine-screening-urinary-incontinence-women-caution-advised - ↑ 15.0 15.1 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: https://www.ncbi.nlm.nih.gov/pubmed/33211585 PMCID: PMC7750618 (available on 2023-01-01) https://www.medscape.com/viewarticle/943772