Adult Routine Preventative Care Recommendations
These recommendations represent a core set of guidelines for average-risk patients from the general population. The guidelines should not supplamt clinical judgment or the needs of individual patients. These guidelines are intended as quality-practice recommendations and are not intended as a description of benefits, conditions of payment, or any other legal requirements of any particular health plan or payor. Each health plan or payor makes its own determination of coverage benefits. In the event that these practice recommendations are inconsistant with any applicable laws or regulations, such laws or regulations take precedence.
 

Health Maintenance Visit

At every age

-Obtain initial/interval history, including family history of disease.

-Perform age appropriate physical exam.

-Provide preventative screenings and counseling as below.

-Update immunizations. For current immunization schedules, refer to teh US Centers for Disease Control and Prevention Adult Immunization Guidelines.
           

Frequency

 18-29 years 30-39 years 40-49 years 50-64 years 65+ years
 

Annually for ages 18-21

Every 1-3 years, depending on risk ages 22-29

 Every 1-3 years, depending on risk factors Every 1-3 years, depending on risk factors Annually Annually
 

Labs & Cancer Screenings

Breast Cancer

 18-39 years 40-49 years 50-64 years 65+ years

-Starting at age 20, perform clinical breast exam and provide self-exam instruction

-Advise mammography for patients at high risk

-Perform clinical breast exam and provide self-exam instruction

-Annual mammography at discetion of clinician/patient

-Perform clinical breast exam and provide self-exam instruction

-Annual mammography

-Perform clinical breast exam and provide self-exam instruction

-Annual mammography thru age 69; > age 70 at clinician/patient discretion
 

Cervical Cancer (Pelvic Exam & Pap Test)
18-65+ years

-Initiate Pap test and pelvic exam at 3 years after first sexual intercourse or by age 21

-If under age 30, perform Pap test annually

-Perform pelvic exam and Pap test every 1-3 years, depending on risk factors. Pap test may be performed at 3 year intervals only after 3 consecutive negative results and age 30 or older.

-The option to omit pap test after age 65 may be offered if there is documented evidence of consistently negative results.
     

Colorectal Cancer

 18-49 years 50-65+ years
  Not routine except for patients at high risk. High risk patients should be screened more frequently using complete colonoscopy at clinician/patient discretion.

-Colonoscopy at age 50 and then every 10 years

OR

-Annual fecal occult blood test plus sigmoidoscopy every 5 years OR double-contrast barium enema every 5 years

OR

-Annual FOBT
 

Testicular & Prostate Cancer
18-39 years 40-49 years 50-65+ years

-Perform clinical testicular exam and provide self-exam instruction at each health maintenance visit

-Prostate cancer screening not routine

-Perform DRE exam for patients at high risk for prostate cancer

-Offer PSA screening for high-risk patients at clinician/patient discretion

-Perform DRE exam

-Offer PSA at clinician/patient discretion
   

Skin Cancer

 18-65+ years

-Perform skin exams every 3 years between teh ages of 20 and 39 and annually age 40 and older, regardless of skin tone and color

-Perform skin exams more frequently at clinician discretion based on risk factors

-Educate about skin cancer

-Counsel to limit exposure to the sun (especially between 10am and 4pm) to fully cover skin with clothing and hats and to use sun block (SPF 15 or greater)

-Discourage use of tanning beds
 

Eye Exam for Glaucoma
18-39 years 40-49 years 50-64 years 65+ years  

-At least once in patients with no rish factors.

-Every 3-5 years in high-risk patients.

-Screen annually in patients with diabetes

-Every 2-4 years

-Screen annually in patients with diabetes

-Every 2-4 years

-Screen annually in patients with diabetes

-Every 1-2 years

-Screen annually in patients with diabetes

  
   

Body Mass Index

18-65+ years

-Screen for overweight. Consult the CDC's growth and body mass index (BMI) charts

-Screen annually for eating disorders. Ask about body image and dieting patterns

-Counsel on the benefits of physical activity and a healthy diet to maintain a desirable weight for height. Offer more focused evaluation and intensive counseling for adults with BMI> 30kg/m2 to promote sustained weight loss for obese adults.
   

Cholesterol

 18-65+ years

-Screen if not previously tested. Screen every 5 years with fasting lipoprotein profile (total cholesterol, LDL cholesterol, HDL cholesterol and trigluceride). If the testing opportunity is nonfasting and total cholesterol is .200 mg/dl or HDL is <40 mg/dl, a follow up lipoprotein profile should be performed. More routine screening for patients with high-risk at clinician discretion.

-If at risk or screened to have high cholesterol and heart disease, counsel on lifestyle changes including a diet low in saturated fats and high in fiber, weight management, and physical activity.
   

Diabetes (Type 2)

 18-65+ years

-Screen every 3 years beginning at age 45. Screen more often and beginning at a younger age for those who are overweight and if risk factors are present.

-A fasting blood sugar is the preferred diagnostic test. The 2-hour oral glucose tolerance test is also acceptable.
   

Hypertension

 18-65+ years
-Screen for high blood pressure at every acute/nonacute medical encounter and at least once every 2 years.
   

Osteoporosis

  
18-29 years 30-39 years 40-64 years 65+ years
-Counsel about preventive measures, such as dietary calcium and vitamin D intake, weight-bearing exercises, and smoking cessation.
   

-Consider risk of osteoporosis in all post-menopausal women

-Cousel on the risks and benefits of hormonal and nonhormonal therapies

-Provide BMD testing for all postmenopausal women who have one or more additional risk factors for osteoporotic fracture

- Provide BMD testing

- Cousel elderly patients on specific measures to prevent falls
 

Sexually Transmitted Infections (Chlamydia, Gonorrhea, Syphilis, & HPV)
18-65+ years  

-Advise about risk factors for sexually transmitted infections (STIs) and counsel about effective ways to reduce the risk of infection

For chlamydia and gonorrhea:

-Sexually active male and female patients under age 25: Screen annually. Consider urine-based screening for women when a pelvic examination is not performed.

-Patients age 25 and over: Screen annually, if at risk.

For syphilis:

-Screen if at risk.Risk factors include: history of and/or current infection with another sexually transmitted infection; having more than one sexual partner within the past 6 months; exchanging sex for money or drugs; and men having sex with other men.

For HPV:

-For age 26 and under, if not previously vaccinated, counsel patients regarding the schedule for HPV vaccine.
 

Hepatitis C
18-65+ years
-Periodic testing of all patients at high risk. Risk factors include: illicit injection drug use; receipt of blood product for clotting problems before 1987 and.or receipt of a blood transfusion or solid organ transplant before July 1992 (if not previously tested); long-term kidney dialysis; evidence of liver disease; a toatoo or body piercing by onsterile needle; risky sex practices (not using condoms, multiple sex partners).