1. Health Promotion and Screening WOMEN’S HEALTHCARE: DIAGNOSIS AND MANAGEMENT

2. What is Health? Definition:  WHO (1948) – “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”  AMA (2003) – “A state of physical and mental well-being” Can you think of other definitions of health? What about health promotion?

3. Prevention as a concept  Primary prevention: services focused on preventing disease in susceptible populations  Examples: health education and counseling, targeted immunizations, lifestyle modification strategies  Secondary prevention: services focused on the early detection and prompt treatment of disease states  Examples: laboratory screening tests, pap smears, screening mammograms  Tertiary prevention: services which limit disability and promote rehabilitation while in disease states  Examples: eye exams for those with diabetes, follow-up exams for recurrence of cancer

4. Counseling and education is KEY!  Some examples:  Dental health  Diet and exercise  Injury prevention (seatbelts, helmets)  Household safety (poisons, guns)  Recreational safety (reflective vests, PFDs)  Fall prevention (railings, fixed carpets)  Sexual behavior  Tobacco use

5. Prevention as a concept  Fits into EVERY patient visit  Applies at all levels  Individual  Family  Community  System

6. US Preventive Services Task Force Recommendations for Preventive Screening  http://www.uspreventiveservicestaskforce.org http://www.uspreventiveservicestaskforce.org

7. USPSTF: A & B Recommendations The Affordable Care Act has mandated that all USPSTF A & B recommendations are covered in full (100%) by every insurance carrier.  Pertains to billable screening and counseling services  Others are often covered, but depends on insurance company (USPSTF A and B Recommendations. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm)

8. USPSTF: A & B Recommendations Primary Care The USPSTF recommends screening for: Blood pressure Lipid disorders Depression IPV Obesity Tobacco use USPSTF A and B Recommendations. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm

9. USPSTF: A & B Recs for Women’s Health Care The USPSTF recommends screening for: Breast cancer Cervical cancer STI risk Chlamydia & gonorrhea HIV Syphilis

10. USPSTF: A & B Recommendations Older Women’s Health Care The USPSTF recommends for/that: Use of aspirin to reduce risk of stroke Mammography Colorectal cancer screening Osteoporosis screening (currently being researched as of 11/2015) USPSTF A and B Recommendations. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm

11. Other preventive screening/counseling recommendations Thyroid screening: insufficient evidence Skin cancer screening: insufficient evidence Vitamin D screening: insufficient evidence in 2014 Ovarian cancer screening: recommendation against routine screening (D) Combined or estrogen-only hormone replacement therapy: recommendation against use Diabetes screening: insufficient evidence for normotensive adults, recommended if co- existing hypertension

12. Screening for Women’s Health  Cervical Cancer Screening  Pap smear every 3 years (21-65 years of age), or pap smear with HPV testing every 5 years (30-65 years)  USPSTF guidelines  Breast Cancer Screening  Mammography every 1-2 years for ages 40-49, then yearly for ages 50 and older  ACOG guidelines  Clinical Breast Exam (CBE) recommended periodically (1-3 years), and self breast exam encouraged for ages 20-39 (or all women)  ACOG/ACS guidelines  BRCA 1/2 testing not recommended unless risk factors present, only recommended with genetic counseling  USPSTF guidelines

13. Resources to know… Healthy People 2020  http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx United States Preventive Services Task Force (USPSTF) and the Affordable Care Act  http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm Centers for Disease Control and Prevention (CDC) Recommended Vaccine Schedule  http://www.cdc.gov/vaccines/schedules/downloads/adult/adult- schedule-easy-read.pdf http://www.cdc.gov/vaccines/schedules/downloads/adult/adult- schedule-easy-read.pdf U.S. Dept of Health and Human Services, Office on Women’s Health  www.womenshealth.gov www.womenshealth.gov

14. Questions?