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Home Books CURRENT Diagnosis & Treatment: Family Medicine, 4e

Chapter 15: Health Maintenance for Adults

Stephen A. Wilson; Lora Cox-Vance; Paul R. Larson; Rachel Simon; David Yuan

INTRODUCTION

On average, each day longer you live, the longer you are likely to live, yet the closer to dying you become. The goal of health maintenance (HM) is to help people live longer and healthier lives.

GENERAL CONSIDERATIONS

In this chapter, the findings and positions of the United States Preventative Service Task Force (USPSTF) are emphasized because it generates the most comprehensive and evidence-based recommendations of any organization. Hence, knowing the USPSTF grading system for its recommendations is important (Table 15-1). The USPSTF is sponsored by the Agency for Healthcare Research and Quality (AHRQ) and is the leading independent panel of private-sector experts in prevention and primary care.

Table 15–1.USPSTF grade definitions.
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Table 15–1.USPSTF grade definitions.
Grade Definition Suggestions for Practice
A USPSTF recommends the service. There is high certainty that the net benefit is substantial. Offer or provide this service.
B USPSTF recommends the service. There is high certainty that the net benefit is moderate or moderate certainty that the net benefit is moderate to substantial. Offer or provide this service.
C USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small. Offer or provide this service only if other considerations support the offering or providing the service in an individual patient.
D USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. Discourage the use of this service.
I statement USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms (risks) of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and risks cannot be determined. Read the clinical considerations section of USPSTF recommendation statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.

This chapter describes prevention then presents HM by the age groups 18-39, 40-49, 50-59, 60-74, and ≥75 years of age. USPSTF Grade A and B recommendations are emphasized with highlights to some areas of special interest or controversy, including sections on immunizations and aspirin.

Health maintenance involves three types of prevention: primary, secondary, and tertiary (Figure 15-1).

Figure 15–1.

The three types of disease prevention.

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PREVENTION

A. Primary Prevention

Targets individuals who may be at risk to develop a medical condition and intervenes to prevent the onset of that condition (eg, childhood vaccination programs, water fluoridation, smoking prevention programs, clean water, and sanitation). The disease does not exist. The goal ...

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