Chapter 10-04: Key Treatments & Interventions in General Medicine

HEALTH CARE MAINTENANCE AND DISEASE SCREENING

These health care maintenance and disease screening guidelines summarize recommendations from the U.S. Preventative Services Task Force (USPSTF) guidelines, other guidelines as indicated, and general best practices. Of note, screening tests aim to identify disease in asymptomatic individuals. Recommendations are population-based and may need to be tailored to individual patients based on the clinical context. The decision to stop routine disease screening should be based on shared-decision making with the patient and should take into account the patient’s functional status, life expectancy, goals, and preferences.

All patients

• History:

  • - Diet/weight, exercise

  • - Alcohol, tobacco, substance use

  • - Sexual history

  • - Depression/anxiety

  • - Intimate partner violence

  • - Advance care planning: Discuss future health care decisions related to the patient’s priorities and values, document code status, identify a surrogate medical decision maker, and complete appropriate documentation (may vary by state: advanced directive, durable power of attorney, physician’s orders for life-sustaining treatment [POLST]); Recommended for all adults, and especially important for patients with multiple co-morbidities and/or advanced age

• Screening tests:

  • - HIV screening for all patients age 15–65 yr. Offer pre-exposure prophylaxis (PrEP) to persons who are at high risk of HIV acquisition

  • - Latent tuberculosis infection (LTBI) screening in persons at increased risk

  • - Hepatitis B virus (HBV) screening in persons at increased risk

  • - Hepatitis C screening in adults age 18–79 yr

  • - Depression screening

• Physical exam: Body mass index (BMI), blood pressure

• Vaccinations: Td(ap) every 10 yr

Women

• 18–39 years:

  • - H+P: See list above under “all patients”. Also ask about contraception and sexual health.

  • - Screening tests:

    • Pap smear (q3 yr if age 21–29 yr; q3 yr or q5 yr if pap/HPV co-testing if age ≥30 yr)

    • If sexually active, gonorrhea/chlamydia screening annually until age 25 yr (and then discretionary). If high risk sexual behavior, offer STD testing more frequently (i.e., q3–6 months)

    • Rubella serology once

  • - Vaccinations: Annual flu shot, HBV series, varicella, HPV vaccination if not already completed (recommended for individuals age 9–26 yr, expanded approval up to age 45 yr)

• 40–49 years:

  • - H+P: See list above under “all patients”

  • - Screening tests:

    • Lipids screening q5 yr starting at age 45 yr, or earlier if risk factors

    • HgA1c q3 yr starting at age 45 yr, or earlier if risk factors

    • USPSTF recommends biennial screening mammogram starting at age 50 yr, but other guidelines recommend starting at age 40 yr so can consider with shared decision-making

    • Pap smear q3 yr or q5 yr if pap/HPV co-testing

  • - Vaccinations: Annual flu shot

• 50–64 years:

  • - H+P: See list above under “all patients”

  • - Screening tests:

    • Lipids q5 yr

    • HgA1c q3 yr

    • Mammogram q2 yr

    • Pap smear q3 yr or q5 yr if pap/HPV co-testing

    • Colon cancer screening (options: FIT q1 yr, flexible sigmoidoscopy q5 yr, colonoscopy q10 yr)

    • Osteoporosis screening if high risk

    • Annual low-dose CT if age ...