PREVENTATIVE HEALTH: STAYING

ONE STEP AHEAD

Faria Chaudhry , PharmD

Molly Corder, PharmD
Saint Joseph Health System
PHRM 571: Ambulatory Care Elective
PASSWORD  Preventative2021
 Define public and preventative health
Define opportunities within patient centered care

Illustrate the significance of preventative health

Illustrate on public health outcomes

Differentiate credible resources for guidance on

Differentiate preventive health
OBJECTIVES

Choose preventive health screenings according

Identify to individualistic patient risk factors

Formulate a preventive health plan with

Formulate appropriate screening recommendations
ABOUT US
 DEFINITIONS

•Public health: “health of the population as a whole-

the science of protecting and improving the health of
people and their communities”

•Preventative health: “recognized proactive health

screenings, maintenance, and counseling in order to
PREVENT future illness and the need for treatment”

CDC foundation 2021

Oxford Languages 2021
TechTarget 2017
 PREVENTATIVE HEALTH CARE
EFFECTS

7 out 10 U.S deaths caused by chronic disease

Vaccines save 2 to 3 million lives every year

Cardiovascular exams can save ~10,000 lives annually

Greater use of preventive services could stop the

loss of two million-life years annually
 WHY DO WE CARE

● Proactivity vs reactivity

● Interventions

● Quality of life

● Healthcare burden
 CENTERS FOR DISEASE CONTROL AND
PREVENTION (CDC)

CDC Mission Statement

“CDC works 24/7 to protect America from health, safety and
security threats, both foreign and in the U.S. Whether diseases
start at home or abroad, are chronic or acute, curable or
preventable, human error or deliberate attack, CDC fights
disease and supports communities and citizens to do the same.”

CDC. About
Organization.
(2021).
HOW TO UTILIZE RECOMMENDATIONS
 SO, WHAT IS AN AWV?

PHQ9 or detailed
Screenings / Mini cog or
depression
immunizations MMSE
screening

Home safety Fall risk

screening assessment Functionality

Whisper test

AAFP 2019
 SCREENINGS

● Annual wellness exam

● Mental wellness exam
● Cognitive assessment
● Physical health screening
○ Osteoporosis
○ Cancers (cervical, breast, prostate, colorectal)
○ Type 2 diabetes
○ Hyperlipidemia
○ Colonoscopy

AAFP 2019
 MENTAL WELLNESS EXAM

o Not at all (0 points)

1. Feeling down, depressed, hopeless
o Several days (1 points)
o More than half the days (2 points)
2. Little interest- pleasure in activities
o Nearly every day (3 points)

Points
0 = no further action needed
1-6 = continue with detailed depression screening questions
AAFP 2019
 COGNITIVE EXAM

Step 1: Three Word Registration Word Recall: 1 point for each word
spontaneously
Example: banana, sunrise, chair ______ (0-3 points) recalled

Clock Draw: Normal clock is 2

points
Step 2: Clock Drawing _____ (0 or 2 points) Abnormal is 0 points

Total score <3 points validated

for dementia
Step 3: Three Word Recall ______ (0-5 points) screening

AAFP 2019
PHYSICAL EXAMS
 Stages Systolic Diastolic
Normal <120 <80
BLOOD Elevated 120-129 <80
PRESSURE
Stage 1 130-139 80-89
Hypertension
Stage 2 >140 > 90
Hypertension
Hypertensive >180 >120
Crisis

CDC AHA 2017

 HYPERTENSION COMPLICATIONS

Cerebrovascular
Heart disease CKD/ faliure
disease

Peripheral
Retinopathy
arterial disease

Drug induced Diseases. Hypertension

 HYPERTENSION SIGNIFICANCE

Every 20
systolic
Future
risk of CV
115 / 75 mmHg
disease
doubles
Every 10
diastolic

Drug induced Diseases. Hypertension

 Who? Adults 40 – 70
years old who are
overweight or obese.
SCREENING FOR
DIABETES: What? Screen for
abnormal glucose and
offer behavioral
counseling

USPSTF. Abnormal Blood

Glucose and Type 2 Diabetes
Mellitus Screening. 2015.
 Screening/test Frequency Complications to avoid

A1c Every 3-6 All of the complications listed

months below

Dental exam 6 months Plaque build up, gingivitis, thrush,

infections

Urine annually Kidney dysfunction, dialysis,

microalbumin/creatinine kidney transplant
DIABETES: ratio

STANDARDS Dilated eye exam annually Retinopathy, cataracts, glaucoma,

OF CARE retinal detachment, blindness

Fasting lipid panel 6-12 months Atherosclerosis, heart attack, stroke

Foot exam annually Neuropathy, infection, ulcer,

Diabetes Care Jan
2020, 43 (Suppleme
gangrene, amputation
nt 1) S1-
S2; DOI: 10.2337/d
c20-Sint
 DIABETIC
FOOT EXAM

Diabetes Care Jan
2020, 43 (Suppleme
nt 1) S1-
S2; DOI: 10.2337/d
c20-Sint
 CHOLESTEROL

Fasting lipid panel

• Every 4-6 years starting at age 20
• Re-evaluate at age 40
• Higher risk patients require more
frequent monitoring

Bear Lake Memorial 2021

Cleveland Clinic 2021.
ACC/AHA 2018
AHA 2020
P R I M A RY

ACC/ AHA 2019

 ASCVD Risk Estimator + (acc.org)
A SC V D

American College of
Cardiology. ASCVD
Risk Estimator Plus.
(2021.)
 OSTEOPOROSIS

Osteopenia
T score: -1 to -2.5

Osteoporosis 
T score: < -2.5

Harvard Health 2020

 NATIONAL OSTEOPOROSIS
FOUNDATION RECOMMENDATIONS

Menopausal Postmenopausal
Women age > Broken bone
Men age > 70 women w/ risk women <65 w/
65 age > 50
factors (RF) RF

X-ray showing
Men 50-69 w/ Back pain + -1½ inches -½ inch from
bone loss or
risk RF Broken Spine from height height in 1 year
break

NOF 2020
 Women

• > 65 years of age

• < 65 with increased risk

Risk
USPSTF
RECOMMENDATIONS • Genetics, alcohol & tobacco use, low body
weight, parental history of hip fracture
• FRAX tool

Men

• No recommendations

USPSTF 2018
 DXA SCAN

Dual Energy X ray absorptiometry  strength of bone/ mineral content

T score: SD of your bone mass vs the average healthy 30 year old’s

Z score: SD of your bone mass vs the average healthy adult YOUR age

American Bone Health 2020.

 1. Age? (40-90) 50

FRACTURE RISK 2. Gender? Female

ASSESSMENT 3. Weight? (kg) 50 kg

TOOL 4. Height? (cm) 162.6 cm (5’4”)

5. Previous Fracture? Yes

6. Parent hip fracture? No

10 yr probability: 7. Current smoker? No

8. Glucocorticoid use? Yes

Major
osteoporotic
• 19% (5 mg/d Prednisone equivalent x 3 mos)

9. Rheumatoid Arthritis? Yes

fracture
10. Secondary Osteoporosis? No
**T1DM, untreated long standing hyperthyroidism,

Hip fracture
• 6% hypogonadisim, premature menopause (<45 Y), chronic
malnutrition, chronic liver disease

11. > 3 Alcohol units/ day? No

12. Femoral neck BMD? n/a

FRAX NOF 2020

 SUPPLEMENTS

Calcium
1,000 mg – 1,200 mg

Vitamin D
800-1,000 IU

USPSTF 2020
 STI/HIV

Who? All pregnant persons with unknown status, adults 15-65 years, younger and older adults with

increased risk

When? At least once 15-65 years old, more often for higher risks persons

What? HIV antigen/antibody test, nontreponemal test, NAAT

Why? More than 12 million Americans are infected with STDs every year. Many STDs are curable

and can be treated quicker if aware. HIV can be virologically suppressed.

USPSTF.
HIV. 2019
 STI/HIV

● Practice safe sex

● Honest conversation with
partners
and healthcare providers
● Get tested regularly
 BIRTH
CONTROL

Southern Hills Hosp & Med Center

 Who? Age 18- 79 years

When? Once

What? HCV antibody test

HEPATITIS C

Why? Most common blood-borne

pathogen and leading cause of
complications from chronic liver
disease
USPSTF. Hepatitis C.
2021
 HEPATITIS VACCINES

Hepatitis Vaccine? Dose recommendations Population

type
A Yes Children 12-23 months old
First dose: now Adolescents: 2-18 years not previously vaccinated
Second dose: 6 months after Other consideration

B Yes First dose: now Children >1 year to adults 18 years old
Second dose: 1 month after 1st dose Other consideration
Third dose: 6 months after 1st dose
Or
First dose: now
Second dose: 1 month after

CDC. C No
Vaccine
Information.
2021
 Cervical

Breast

CANCER Prostate
SCREENINGS
Colon

Lung

ACA 2021
AGE
21-29
Men Women
• If increased risk* • Cervical cancer  age 25
• Colon cancer • (Age 21 per USPSTF)
• If increased risk*
• Breast cancer

ACA 2021
AGE 30-39

Men Women
• If increased • Cervical cancer  q 5 years
risk* • If increased risk*
• colon • Breast cancer
• Colon cancer

ACA 2021
AGE 40-49

Men Women
• Colon  Age 45 • Breast  annually at 45*
• USPSTF age 50-75 • Cervical  q 5 years
• If increased risk* • Colon  Age 45
• prostate

ACA 2021
AGE 50-64

Men Women

• Colon • Breast  Annually 50-54,

• Prostate • 55 + every other year
• UPSTF 55-69 • USPSTF  biennial age 50-74
(choice)
• Cervical  q 5 years
• Colon

ACA 2021
AGE 65 OR
OLDER

• Men • Women

• Colon  through age 75 • Breast  q 2 years

• Prostate  consider • Cervical  NO if last 10
lifespan years normal
• Colon  through age 75

ACA 2021
 SMOKING CESSATION

5 A’s: Ask, Advise, Assess, Assist, Arrange CDC.

Health
Effects
Smoking.
2021
 SMOKING CESSATION

Nicotine replacement therapy Nicotine gym, patch, lozenge,

(NRT) nasal spray, inhaler

Psychotropics Bupropion SR (Zyban)

Partial nicotine receptor Varenicline (Chantix)

agonist

CNS Drugs.
2013
IMMUNIZATIONS: GREATEST PUBLIC
HEALTH ACHIEVEMENT

CDC.
Immunizations.
2021
 IMMUNIZATION SCHEDULE

Influenza Pneumonia Hepatitis B

• Yearly • 1 dose at 65 years or older • 3 doses for individuals at
or earlier for individuals at high risk
high risk (unless
immunocompromised)

Shingles (Shingrix) Tetanus (Tdap) Covid-19

• 2 doses (at 50 years or • Every 10 years • TBD
older)

CDC.
Immunizations.
2021
 REFERENCES

• What is public health? CDC foundation. 2021. Accessed 20 March, 2021. Available at: www.cdcfoundation.org/what-public-health

• Public health. Oxford Languages. Oxford University Press. 2021. Accessed 20 March 2021. Available at: languages.oup.com/google-dictionary-en

• Preventative Health. TechTarget. 2017. Accessed 20 March 2021. Available at: whatis.techtarget.com/definition/preventative-health

• CDC. About organization. (2021).

• Bluestein, D. Medicare Annual Wellness Visit: Getting Paid for What We Do Best. American Academy of Family Physicians. 2019. Accessed 30 March, 2021. Available at:
aafp.org/dam/AAFP/documents/practice_management/webcasts/AWVGettingPaidBest.pdf.

• Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of
Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019.

• Trinkley K, Page R. Hypotension. Drug Induced Diseases : Prevention, detection, management. Chapter 28.

• USPSTF. Abnormal Blood Glucose and Type 2 Diabetes Mellitus Screening. 2015.

• Diabetes Care Jan 2020, 43 (Supplement 1) S1-S2; DOI: 10.2337/dc20-Sint

• Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE,
Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/ PCNA guideline on the management of blood cholesterol: executive summary:
a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e1046– e1081. DOI: 10.1161/CIR.0000000000000624.

• Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE,
Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/ PCNA guideline on the management of blood cholesterol: executive summary:
a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:e1046– e1081. DOI: 10.1161/CIR.0000000000000624.

• American College of Cardiology. ASCVD Risk Estimator Plus. (2021.)

• Osteopenia: When you have weak bones, but not osteoporosis. Harvard Health Publishing Harvard Medical School. 2020. https://www.health.harvard.edu/womens-health/osteopenia-when-you-have-weak-bones-but-not-osteoporosis

• Bone Density Exam/ Testing. NOF. 2020. https://www.nof.org/patients/diagnosis-information/bone-density-examtesting/

 REFERENCES

• Bone Density Exam/ Testing. NOF. 2020. https://www.nof.org/patients/diagnosis-information/bone-density-examtesting/

• Osteoporosis to Prevent Fractures: Screening. USPSTF. 26 June 2018. Accessed 1 September, 2020. Available at:
https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/osteoporosis-screening
• Understanding Bone Density Results. American Bone Health. 2020. https://americanbonehealth.org/bone-density/understanding-the-bone-density-t-score-and-z-score/
• Fracture Risk Assessment Tool. FRAX. https://www.sheffield.ac.uk/FRAX/tool.aspx?country=9
• Risk Assessment (FRAX). NOF. 2020. https://www.nof.org/patients/diagnosis-information/risk-assessment-frax/
• Institute of Medicine (US) Committee of Prevention and Control of Sexually Transmitted Disease. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washingont, DC: National
Academies Press. 1997.
• U.S Preventive Services Task Force. Human Immunodeficiency Virus Infection Screening. U.S Preventive Services Task Force. 2019.
• Mody SK, Han M. Obesity and contraception. Clin Obstet Gynecol. 2014;57(3):501-507. doi:10.1097/GRF.0000000000000047
• U.S Preventive Services Task Force. Hepatitis C Virus Infection in Adolescents and Adults: Screening. (2021).
• CDC. Vaccine Information. (2021).
• Cancer Screening Guidelines by Age. American Cancer Society. 2021. Accessed 31 March, 2021. Available at: cancer.org/healthy/find-cancer-early/screening-recommendations-by-age.html.
• USPSTF. Lung Cancer. (2021)
• CDC. Health Effects, Smoking & Tobacco Use. (2021).
• Shahab L, Brose LS, West R. Novel delivery systems for nicotine replacement therapy as an aid to smoking cessation and for harm reduction: Rationale, and evidence for advantages over existing
systems. CNS Drugs 2013; 27:10079
• Hussain, A., Ali, S., Ahmed, M., & Hussain, S. (2018). The Anti-vaccination Movement: A Regression in Modern Medicine. Cureus, 10(7), e2919. https://doi.org/10.7759/cureus.2919
• Hussain, A., Ali, S., Ahmed, M., & Hussain, S. (2018). The Anti-vaccination Movement: A Regression in Modern Medicine. Cureus, 10(7), e2919. https://doi.org/10.7759/cureus.2919

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