The Guidelines for Adults
By Dr. Sanders | April 15, 2008
There are recommendations for caring for adult patients. When medicine focuses only on problems and disease, it is easy to miss doing some of these simply things. The better approach, and out goal at PCPG is to also address prevention. Patients should be screened for risks associated with the family’s history, their own lifestyles and behaviors and for conditions common to their age group. Take a look at the list below.
Table 1. Adult Preventive Services That Providers and Care System Must Deliver
(Based on Best Evidence) (Level I)
| Service | 19 to 39 Years | 40 to 64 Years | Over 65 Years |
|---|---|---|---|
| Aspirin chemoprophylaxis counseling | Discuss with postmenopausal women, men above age 40, and younger men and women who are at increased risk for coronary heart disease (CHD). | ||
| Breast cancer screening | Annual mammogram for women age 40 to 49 years with high risk factors. Mammogram every 1 to 2 years for women age 50 to 75 years. | Mammogram every 1 to 2 years for women age 50 to 75 years. | |
| Calcium chemoprophylaxis counseling | Counsel adult women to use calcium supplements to prevent fractures. | ||
| Cervical cancer screening | Beginning at age 21 or three years after first sexual intercourse, whichever is earlier; every 3 years after 3 consecutive normal Pap smears over 5 years | Every 3 years after 3 consecutive normal Pap smears over 5 years | Women 65 years and older with new sexual partner should resume routine screening. |
| Chlamydia screening | All sexually active women aged 25 years and younger, and older women at increased risk for infection | ||
| Colorectal cancer screening | Ages 50 to 80, or if African American 45 to 80, at appropriate intervals as determined by whichever screening method is chosen. | ||
| Hypertension screening | Blood pressure every 2 years if less than 120/80; every year if 120 to 139/80 to 89 mm Hg | ||
| Influenza immunization | Annually throughout entire flu season for individuals age 50 and older, those at high risk, and all persons who wish to decrease the likelihood of contracting influenza. | ||
| Lipid screening | Fasting fractionated lipid screening for men over age 34 every five years | Fasting fractionated lipid screening for men over age 34 and women over age 44 every five years. | |
| Pneumococcal immunization | Immunize high-risk groups once. Re-immunize those at risk of losing immunity once after 5 years. | Immunize at 65 if not done previously. Re-immunize once if 1st received more than 5 years ago and before age 65, or an appropriate immunocompromising condition is present. | |
| Problem drinking screening and brief counseling | Screen for problem drinking among adults and provide brief counseling. | ||
| Tobacco use screening and brief intervention | Assess adults for tobacco use and provide ongoing cessation services. | ||
| Vision screening | Screen adults ages 65 or greater routinely. | ||
Table 2. Adult Preventive Services That Providers and Care Systems Should Deliver
(Based on Good Evidence) (Level II)
| Service | 19 to 39 Years | 40 to 64 Years | Over 65 Years |
|---|---|---|---|
| Abdominal aortic aneurysm screening | Men ages 65 to 74 who have ever smoked (greater than 100 cigarettes in lifetime) | ||
| Depression screening | Routine screening for adult patients with depression if there are systems in place to ensure accurate diagnosis, effective treatment, and careful follow-up | ||
| Folic acid chemoprophylaxis counseling | Counsel women of childbearing age routinely on use of folic acid supplements to prevent birth defects. | ||
| Hearing screening | Subjective hearing screen followed by counseling on hearing aid devices and making referrals as appropriate | ||
| Hepatitis B immunization | Universal immunization | Immunize those at high risk. | |
| Herpes zoster/shingles immunization | Immunize at age 60 or older. | ||
| Human papillomavirus (HPV) immunization | Catch up if appropriate, three-dose series | ||
| Inactivated polio vaccine (IPV) immunization | Immunize if not previously immunized. | ||
| Measles, mumps, rubella (MMR) immunization | Persons born during or after 1957 should have one-dose measles; a second dose may be required in special circumstances | ||
| Obesity screening | Record height, weight, and body mass index (BMI) at least annually for screening. | ||
| Osteoporosis screening | Assess and discuss risk factors for osteoporosis, and its primary prevention, with all patients for preventive health visits. | ||
| Tetanus-diphtheria immunization | Immunize adults every 10 years. | ||
| Varicella immunization | For all adults who do not have evidence of immunity to varicella, give two doses of varicella vaccine with at least 28 days between first and second doses. | ||
Topics: Immunizations, Patient Information | No Comments »
Should you stop your Vytorin or Zetia?
By Dr. Sanders | April 14, 2008
The drugs Vytorin and Zetia are used to treat high cholesterol. Vytorin is a combination of Zocor(simvastatin) and Zetia(ezetimibe). These drugs have been in the news in recent weeks because of the results the ENHANCE* drug trial. If you listen to the evening news, NPR, Fox, CNN or read the newspaper, it has been hard to avoid the murmur about this drug trial. There was much speculation about the results long before any concensus statement was issues.
Finally, we have a concensus statement from the American College of Cardiologists. The ACC website has the full statement.
The bottom line is that lowering total cholesterol and LDL are still goals of hyperlipidemia therapy. Zetia and Vytorin are still on the market. No “black box warnings” have been added to their package labeling. But, if you are on either of these drugs and have reservations regarding their safety call and make an appointment to discuss the issues with your doctor.
Topics: Patient Information, In the News | No Comments »
Our No-Show Policy:
By melissab | February 19, 2008
As a courtesy to our patients it is not our policy to charge for no-show appointments. However, we do ask that you contact our office at least 24hrs prior to your scheduled appointment if you need to cancel or reschedule so that we may offer the appointment time to another ill patient. If you fail to cancel and no-show for three scheduled appointments you may be discharged from the practice.
According to the Medicare guidelines, a fee can be charged for a no-show appointment due to a missed business opportunity. Primary Care Physicians of Gainesville does not have any intention of adopting this policy. We appreciate our patients and would like to thank you for your consideration of our policies.
Topics: Office Policies | No Comments »