Adult Preventative Health Schedule Grade A and B

What are the 4 ways we can organize USPSTF recommendations?

• By Grade

• By Age Group

• By Sex at Birth

• By Category

What are the 3 categories we can organize USPSTF recommendations?

• Screening

• Preventive therapies

• Counseling recommendations

What are 4 things you should know for each reccomendation?

• Population

• Recommendation statement

• Special considerations for application

• Applicable actions/preventive therapies/counseling

What are 5 examples of Grade A Screening Recommendations?

• HTN

• Syphilis

• Colorectal Cancer*

• HIV

• Cervical Cancer

What are examples of Grade B Screening Recommendations?

• Prediabetes and Type 2 Diabetes

• Abdominal Aortic Aneurysm

• Osteoporosis

• Breast Cancer

• BRCA Related Cancer*

• Lung Cancer

• Anxiety disorders

• Depression and Suicide risk

• Unhealthy drug use

• Unhealthy alcohol use*

• Intimate Partner violence and elder abuse

• Obesity/weight loss

• Latent Tuberculosis

• Chlamydia and Gonorrhea

• Hepatitis B

• Hepatitis C

What preventative therapy grade is HIV pre exposure prophylaxis?

Grade A

What preventative therapy grade is folic acid supplementation if capable of conceiving?

Grade A

What preventative therapy grade is tobacco use and cessation?

Grade A

What preventative therapy grade is statin use for primary prevention of CVD?

Grade B

What preventative therapy grade is primary prevention of breast cancer?

Grade B

What are 4 Grade B counseling recommendations?

• diet/activity for CVD prevention

• STI behavioral counseling

• skin cancer prevention behavioral counseling

• fall prevention (exercise interventions) in community dwelling older adults

What screening grade is general screening for HTN?

Grade A

What population gets screened for HTN?

adults 18 years or older without known history

What is the USPSTF reccomendation for HTN screening?

obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment.

What is the HTN Screening test?

• Initial screening – office blood pressure measurement (OBPM) (greater than 130/80)

• Confirmation using ambulatory blood pressure measurement (ABPM) prior to initiation of treatment

What intervention is recommended for HTN?

Lifestyle changes, pharmacotherapy, or both

What are the 2 steps to implement HTN screening?

• Step 1: screen - measure BP with an office blood pressure measurement (> 130/80 or >140/90)

• Step 2: confirm - take BP measurements outside of the clinical setting to confirm diagnosis before starting treatment

What is the screening interval for HTN?

annually for adults 40+ or adults with risk factors

What are the 7 risk factors for HTN?

• Older age

• Obesity

• Family history

• Black race

• High sodium diet

• Excessive alcohol consumption

• Physical inactivity

Why is HTN screening important?

more than ½ of adult deaths

What are 3 conditions that HTN is a risk factor for?

• coronary artery disease

• CHF

• stroke

(contributes to atherosclerosis and peripheral vascular disease)

What are 4 pharmacotherapy treatments for HTN?

• ACE inhibitors

• Thiazide diuretics

• Calcium channel blockers

• Beta blockers

What are 3 lifestyle changes to help with HTN?

• Diet

• Exercise

• Alcohol cessation

What general screening grade is obesity and overweight?

Grade B

What population get screened for obesity?

all adults

What is the reccomendation for obesity?

“offer or refer adults with a body mass index (BMI) of 30 or higher (calculated as weight in kilograms divided by height in meters squared) to intensive, multicomponent behavioral interventions.”

What screening test is used for obesity?

BMI (or sometimes weight circumference)

What intervention is used for obesity?

Achieve or maintain a 5% or greater weight loss through dietary changes and increased physical activity

What general screening grade is pre-diabetes/diabetes?

Grade B

What population gets screened for diabetes?

Asymptomatic adults aged 35 – 70 with BMI >25 kg/m2

What is the reccomendation for diabetes?

Screen for prediabetes and type 2 diabetes, and offer or refer patients with prediabetes to effective preventive interventions

(*no optimal interval, if asymptomatic and normal screening tests then every 3 years may be reasonable)

What 3 screening tests are used for diabetes?

• Fasting plasma glucose (>100 pre diabetes, >126 mg/dL diabetes)

• HbA1c (≥5.7% pre-diabetes, ≥ 6.5% diabetes)

• Oral glucose tolerance test (≥ 140 mg/dL prediabetes, ≥ 200 mg/dL diabetes)

What intervention is used for diabetes?

• Lifestyle modifications – diet and physical activity

• Metformin has demonstrated efficacy (off label)

What general screening grade is osteoporosis?

Grade B

What population gets screened for osteoporosis?

All Women 65 and older, and <65 at increased risk

What is the reccomendation for osteoporosis?

“screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older… and women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool”

What 3 screening tests are used for osteoporosis?

• Central DXA

• Peripheral DXA

• Quantitative Ultrasound

What 4 interventions are used for osteoporosis?

• Bisphosphonates

• Selective estrogen receptor modulator

• Parathyroid hormone

• Adequate calcium (1200 mg daily) and vitamin D (800 units daily) ingestion

What are 4 risk factors for osteoporosis?

• Parental history of hip fracture

• Smoking

• Excessive alcohol consumption

• Low body weight

How many risk factors for osteoporosis needs to be present to utilize a clinical risk assessment tool to determine who gets bone measurement testing?

at least 1

What are 2 clinical risk assessment tools for osteoporosis?

• Simple calculated osteoporosis risk estimation (SCORE)

• FRAX tool – gives 10 year probability of fracture

What general screening grade is abdominal aortic aneurysm?

Grade B

What population of people get screened for AAA?

MEN 65 to 75 years if EVER SMOKER

(Can selectively offer screening to 65 to 75 if never smoked (C recommendation)

What is the reccomendation for AAA?

The USPSTF recommends 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.

What is the screening test for AAA?

ONE TIME ultrasound

What is the intervention for AAA?

If positive: Treatment of AAA will depend on aneurysm size, the risk of rupture, and the risk of operative mortality

What grade is general screening for depression?

Grade B

What grade is general screening for suicide?

I statement

What population gets screened for depression?

All adults who do not have a diagnosed mental health disorder and are not outwardly showing recognized signs or symptoms of depression

What is the screening reccomendation for depression?

adult population, including pregnant and postpartum persons, and older adults

What 2 screening tests are used for depression?

• Patient Health Questionnaire (PHQ) – depression

• Beck Hopelessness Scale or SAD PERSONS scale – suicide risk

What intervention is used for depression?

If positive: should have further evaluation for diagnosis confirmation, determine symptoms severity, identify comorbid psychological problems

What PHQ-9 score indicates a person has minimal or absent depression and may not need further assessment or treatment?

0-4

What PHQ-9 score indicates a person has mild depression?

5-9

What PHQ-9 score indicates a person has moderate depression?

10-14

What action will likely need to be taken if a person has mild or moderate depression?

further assessment and treatment

What PHQ-9 score indicates a person has moderately severe depression?

15-19

What PHQ-9 score indicates a person has severe depression?

20-27

What action needs to be taken if a person has moderately severe or severe depression?

further assessment and treatment using antidepressant, psychotherapy or combination of both

What is the general screening grade for anxiety?

Grade B

What population gets screened for anxiety?

All adults 64 years or younger (including pregnant and postpartum)

What is the screening reccomendation for anxiety?

The USPSTF recommends screening for anxiety disorders in adults, particularly if following risk factors:

(Female sex, stressful life events, substance use, parental history of mental disorders, low socioeconomic status, widowed or divorced marital status)

What 3 screening tests are used for anxiety?

• Generalized Anxiety Disorder (GAD) scale

• Edinburg Postnatal Depression Scale (EPDS) anxiety subscale

• Geriatric Anxiety Scale (GAS)

What intervention is used for anxiety?

If positive: evaluated further for diagnosis and, if appropriate, are provided or referred for evidence-based care

What GAD-7 score indicated further evaluation?

scores ≥ 10

What grade is general screening for unhealthy drug use?

Grade B

What population gets screened for unhealthy drug use?

All adults 18 years or older

What is the screening reccomendation for unhealthy drug use?

Ask questions about unhealthy drug use in adults age 18 years or older when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred.

(Screening refers to asking questions about unhealthy drug use, not testing biological specimens.)

What 2 screening tests are used for unhealthy drug use?

• NIDA (National Institute on Drug Abuse) Quick Screen

• ASSIST (Smoking and Substance Involvement Screening Test)

What intervention is used for unhealthy drug use?

If positive: refer for counseling or pharmacotherapy (opioid use disorders)

What general screening grade is unhealthy alcohol use?

Grade B

What population gets screened for unhealthy alcohol use?

All adults, 18 years or older

What is the reccomendation for unhealthy alcohol use?

Screen for unhealthy alcohol use in primary care settings in adults 18 years or older and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use

What screening tests are used for unhealthy alcohol use?

• Start with AUDIT–C or SASQ (1-3 item test)

• If above positive, f/u with 10-item AUDIT test

What interventions are used for unhealthy alcohol use?

If positive: refer for counseling, detox, or pharmacologic therapy

• Benzodiazepines

• Naltrexone – if not currently taking opioids

• Disulfiram – if no EtOH for at least 12 hours and patient preference

What test do you use for unhealthy alcohol use if initial screening is positive?

AUDIT

What general screening grade is intimate partner violence?

Grade B

What population gets screened for IPV?

Women of reproductive age

What is the reccomendation for IPV?

The USPSTF recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services.

(*Evidence is insufficient to assess the balance of benefits and harms of screening for abuse and neglect in all older or vulnerable adults)

What 3 screening tests are used for IPV?

• Partner Violence Screen

• HARK (Humiliation, Afraid, Rape, Kick)

• WAST (Woman Abuse Screening Tool)

What is the intervention for IPV?

If positive: refer for support services

What is the reccomendation title for IPV?

“screening for intimate partner violence, elder abuse, and abuse of vulnerable adults”

When should IPV tests be done?

when partner is not present

What are 3 questions to screen for IPV?

• have you been hit, kicked, punched, or otherwise hurt by someone within the past year? if so, by whom?

• do you feel safe in your current relationship?

• is there a partner from a previous relationship who is making you feel unsafe now?

What is HARK?

humiliation, afraid, rape, kick

(4 items/questions, asks about violence in past year)

What screening tool has 8 items and asses physical and emotional partner violence?

women abuse screening tool (WAST)

What are 10 risk factors for IPV?

• Other forms of violence in relationship

• Younger age

• Mental health disorders

• Unplanned pregnancy

• Having parents with low education level

• Substance abuse

• Mental health disorders

• Early life exposure to violence

• Gender differs from biological sex

• Sexual orientation identifying as bisexual or lesbian

What is elder abuse?

a trusted person (ex caregiver) causes or creates risk of harm to an older adult (60 years and older)

What are 5 types of elder abuse?

• physical abuse

• sexual abuse

• emotional or psychological abuse

• neglect

• financial abuse

What are 3 associated signs of physical abuse?

• bruising

• wounds

• unexplained fractures/injuries

What are 2 associated signs of sexual abuse?

• STI

• genital injuries

What are 5 associated signs of emotional or psychological abuse?

• fear

• anxiety

• distress

• aggression/agitation

• avoidance

What are 3 associated signs of neglect?

• malnutrition

• poor hygiene

• dehydration

What is the intervention for elder abuse?

• reporting through department of social services (adult protective services)

Do PA’s have to report elder abuse?

Yes, mandated reporters

What grade is general screening grade for tobacco use?

Grade A

What population gets screened for tobacco use?

All adults, including pregnant persons

What is the screening reccomendation for tobacco use?

Ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and (FDA) approved pharmacotherapy for cessation to nonpregnant adults who use tobacco

What screening test is used for tobacco use?

Ask patient about tobacco use

What intervention is used for tobacco use?

Behavioral counseling, pharmacotherapy, or combination