Ages 40-64

Schedule

Every 1-3 years. The recommended schedule applies only to the periodic visit itself. The frequency of the individual preventive services is left to clinical discretion (except as indicated). The preventive services are listed below.

DISCLAIMER: Coverage of preventive services varies under PPO and indemnity plans. Members covered under these policies need to refer to their Certificate of Coverage or contact a customer service representative for information regarding covered services.

Screening

History:

• Dietary intake
• Physical activity
• Tobacco/alcohol/drug use
• Sexual practices

Physical Exam:

• Height and weight
• Blood pressure
• Clinical breast exam-annually for women >40

  High Risk Groups:

• Complete skin exam [HR1]
• Complete oral cavity exam [HR2]
• Palpation for thyroid nodules[HR3]
• Auscultation for carotid bruits [HR4]

Laboratory/Diagnostic Procedures:

• Nonfasting total blood cholesterol-every 5 years females age 45-70; males age 35-70
• Papanicolaou smear every 3 years after 2 normal results (note: women who have had a hysterectomy without malignancy may not need pap test).
• Screening mammography for women 40-50, every 1-2 years as per the discretion of the patient and her physician
• Annual screening mammography for women 50 and older
• Fecal occult blood-annually beginning age 50 and/or sigmoidoscopy 3-5 yrs

  High Risk Groups:

• Plasma glucose [HR5]
• VDRL/RPR [HR6]
• Urinalysis for bacteriuria [HR7]
• Chlamydia testing [HR8]
• Gonorrhea culture [HR9]
• Counseling and testing for HIV [HR10]
• Tuberculin skin test (PPD) [HR11]
• Hearing [HR12]
• Electrocardiogram [HR13]
• Fecal occult blood and sigmoidoscopy [HR14]
• Fecal occult blood and Colonoscopy or air contrast barium enema with sigmoidoscopy [HR15]

Immunizations and/or Prophylaxis

• Tetanus-diphtheria (Td) booster-every 10 years

  High Risk Groups:

• Hepatitis B vaccine [HR25]
• Pneumococcal vaccine [HR26]
• Influenza vaccine [HR27]-annually

Patient and/or Parent Counseling

Diet and Exercise:

• Fat (especially saturated fat), cholesterol, complex carbohydrates, fiber, sodium and calcium (for women)
• Caloric balance
• Selection of exercise program

Substance Use:

• Tobacco cessation
• Limiting alcohol consumption.
• Driving/other dangerous activities while under the influence.
• Treatment for abuse.

  High Risk Groups:

• Sharing/using unsterilized needles and syringes [HR18]

Sexual Practices:

• Sexually transmitted diseases:
• Partner selection, condoms, anal intercourse
• Unintended pregnancy and contraceptive options

Injury Prevention:

• Safety belts
• Safety helmets
• Smoking near bedding or upholstery
• Smoke detector

  High Risk Groups:

• Back-conditioning exercises [HR19]
• Prevention of childhood injuries [HR20]
• Falls in the elderly [HR21]

Dental Health:

• Regular tooth brushing, flossing, dental visits

Other Primary Prevention Measures:

High Risk Groups:

• Discussion of aspirin therapy [HR23]
• Discussion of estrogen replacement therapy [HR24]
• Skin protection for ultraviolet light [HR22]

Remain Alert for:

• Depressive symptoms
• Suicide risk factors [HR16]
• Signs of physical abuse or neglect
• Abnormal bereavement
• Malignant skin lesions
• Peripheral arterial disease [HR17]
• Tooth decay, gingivitis, loose teeth

Leading Causes of Death

• Malignant neoplasms
• Heart disease
• Motor vehicle injuries
• HIV infection Suicide
• Homicide

Definitions of High Risk Patients

These definitions apply to the category of Ages 40-64 Years only.

TERM DEFINITION

• HR1: Persons with family or personal history of skin cancer, increased of occupational or recreational exposure to sunlight, or clinical evidence of precursor lesions (e.g., dysplastic nevi, certain congenital nevi).
  
  
• HR2: Persons with exposure to tobacco or excessive amounts of alcohol, or those with suspicious symptoms or lesions detected through self-examination.
  
  
• HR3: Persons with a history of upper-body irradiation.
  
  
• HR4: Persons with risk factors for cerebrovascular or cardiovascular disease (e.g., hypertension, smoking, CAD, atrial fibrillations, diabetes) or those with neurologic symptoms (e.g., transient ischemic attacks) or history of cerebrovascular disease.
  
  
• HR5: The markedly obese, persons with a family history of diabetes, or women with a history of gestational diabetes.
  
  
• HR6: Prostitutes, persons who engage in sex with multiple partners in areas which syphilis is prevalent, or contacts of persons with active syphilis.
  
  
• HR7: Persons with diabetes.
  
  
• HR8: Persons who attend clinics for sexually transmitted diseases; attend other high risk health care facilities (e.g., adolescent and family planning clinics); or have other risk factors for Chlamydia infections (e.g., multiple sexual partners or a sexual partner with multiple sexual contacts).
  
  
• HR9: Prostitutes, persons with multiple sexual partners or a sexual partner with multiple contacts, sexual contacts of persons with culture-proven gonorrhea, or persons with a history of repeated episodes of gonorrhea.
  
  
• HR10: Persons seeking treatment for sexually transmitted diseases; homosexual and bisexual men; past or present intravenous (IV) drug users; persons with a history of prostitution or multiple sexual partners; women whose past or present sexual partners were HIV-infected, bisexual or IV drug users; persons with long-term residence or birth in an area with high prevalence of HIV infection; or persons with a history of transfusion between 1978 and 1985.
  
  
• HR11: Household members of persons with tuberculosis or others at risk for close contact with the disease (e.g., staff or tuberculosis clinics, shelters for the homeless, nursing homes, substance abuse treatment facilities, dialysis units, correctional institutions); recent immigrants or refugees from countries in which tuberculosis is commons (e.g., Asia, Africa, Central and South America, Pacific Islands); migrant workers; residents of nursing homes, correctional institutions or homeless shelters; or persons with certain underlying medical disorders (e.g., HIV infection).
  
  
• HR12: Persons exposed regularly to excessive noise.
  
  
• HR13: Persons with two or more cardiac risk factors (high blood cholesterol, hypertension, cigarette smoking, diabetes mellitus, family history of CAD); persons who would endanger public safety were they to experience sudden cardiac events (e.g., commercial airline pilots); or sedentary or high-risk persons planning to begin a vigorous exercise program.
  
  
• HR14: Persons age 50 and older who have first-degree relatives with colorectal cancer; a personal history of endometrial, ovarian, or breast cancer; or previous diagnosis of inflammatory bowel disease, adenomatous polyps, or colorectal cancer.
  
  
• HR15: Persons with a family history of familial polyposis coli or cancer family syndrome.
  
  
• HR16: Recent divorces, separation, unemployment, depression, alcohol or other drug abuse, serious medical illnesses, living alone, or recent bereavement.
  
  
• HR17: Persons over age 50, smokers, or persons with diabetes mellitus.
  
  
• HR18: Intravenous drug users.
  
  
• HR19: Persons at increased risk for low back injury because of past history, body configuration, or type of activities.
  
  
• HR20: Persons with children in the home or automobile
  
  
• HR21: Persons with older adults in the home.
  
  
• HR22: Persons with a family history of skin cancer, large number of moles, light skin/hair/eye color.
  
  
• HR23: Persons who have risk factors for myocardial infarctions (e.g., high blood cholesterol, smoking, diabetes mellitus, family history of early-onset CAD) and who lack a history of gastrointestinal or other bleeding problems, and other risk factors for bleeding or cerebral hemorrhage.
  
  
• HR24: Perimenopausal women at increased risk for osteoporosis (e.g., Caucasian, low bone mineral content, bilateral oophorectomy before menopause or early menopause, slender build) and who are without known contraindications (e.g., history of undiagnosed vaginal bleeding, active liver disease, thromboembolic disorders, hormone-dependent cancer).
  
  
• HR25: Homosexually active men, intravenous drug users, recipients of some blood products, or persons in health-related jobs with frequent exposure to blood or blood products.
  
  
• HR26: Persons with medical conditions that increase the risk of pneumococcal infection (e.g., chronic cardiac or pulmonary disease, sickle cell disease, nephrotic syndrome, Hodgkin's disease, asplenia, diabetes mellitus, alcoholism, cirrhosis, multiple myeloma, renal disease, or conditions associated with immunosuppression).
  
  
• HR27: Residents of chronic care facilities or persons suffering from chronic cardiopulmonary disorders, metabolic disease (including diabetes mellitus), hemoglobinopathies, immunosuppression, or renal dysfunction.