Developed through the APTR Initiative to Enhance Prevention and Population Health Education in collaboration with the Brody School of Medicine at East Carolina University with funding from the Centers for Disease Control and Prevention ID: 788983
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Slide1
Module 3:Incorporating a Prevention History into the Medical Interview
Developed through the APTR Initiative to Enhance Prevention and Population
Health Education in collaboration with the Brody School of Medicine at East Carolina University with funding from the Centers for Disease Control and Prevention
Slide2Acknowledgments APTR wishes to acknowledge the following individual that developed this module:
Suzanne Lazorick, MD, MPH
Departments of Pediatrics and Public Health Brody School of Medicine at East Carolina University
This education module is made possible through the Centers for Disease Control and Prevention (CDC) and the Association for Prevention Teaching and Research (APTR) Cooperative Agreement, No. 5U50CD300860. The module represents the opinions of the author(s) and does not necessarily represent the views of the Centers for Disease Control and Prevention or the Association for Prevention Teaching and Research.
Slide3Presentation ObjectivesDiscuss the importance of prevention in terms of patient goals, health outcomes and economic impactDescribe strategies for incorporating prevention when obtaining a patient’s medical history
Describe and categorize the essential elements of a preventive history
Identify age-appropriate screening activities using the Age-Specific Preventive History Cards
Slide4Patient goals: What do patients come to a medical provider for?
Help with a specific problem
Treatment of one or more problems
To feel better
To be healthier
To live longer
Slide5“The physician’s function is fast becoming social and preventative, rather than being individual and curative. Upon him society relies to ascertain, and through measures essentially educational, to enforce conditions to prevent disease…”
Abraham Flexner
The Flexner Report on Medical Education in the United States and Canada, 1910
Abraham Flexner, 1910
Slide6Slide7Age-adjusted percentages of persons aged ≥20 years with diabetes, by county — United States, 2007
www.cdc.gov/mmwr November 20, 2009 / Vol. 58 / No. 45
Slide8Slide9Outcomes: Leading Causes of DeathHeart DiseaseCancer
Stroke
Respiratory Diseases
Injuries
Diabetes
Alzheimer’s Disease
Pneumonia/Flu
Kidney Disease
Septicemia
Slide10Leading Preventable * Causes of DeathHeart Disease*Cancer
*
Stroke
*Respiratory Diseases*Injuries
*
Diabetes
*
Alzheimer’s Disease
?
Pneumonia/Flu
*
Kidney Disease
*
Septicemia
*
Slide11Percent of all deaths
Causes of Death, United States 2000
Source:
Mokdad A, Marks JS, Stroup DE, Gerberding JL. Actual causes of death in the United States. JAMA 2004; 291(10):1238-1245. Correction published JAMA 2005; 293(3): 293-294.
Slide12Source: Mokdad A, Marks JS, Stroup DE, Gerberding JL. Actual causes of death in the United States. JAMA 2004; 291(10):1238-1245. Correction published JAMA 2005; 293(3): 293-294.
18.1%
15.2%
3.5%
3.1%
2.3%
1.8%
1.2%
0.8%
0.7%
0%
5%
10%
15%
20%
Illicit Drug Use
Sexual Behavior
Firearms
Motor Vehicles
Pollution/Toxic
Infectious Agents
Alcohol Consumption
Poor Diet and Physical Activity
Smoking
Percent of all deaths
Underlying
Causes
of Death, United States 2000
Slide13Rethinking Current Approaches
80% of
Costs
Stem from
preventable chronic
conditions
75% of
costs
20% of
claimants
Slide14Importance of PreventionEconomic ImpactEvery $1 spent on immunization saves $16.50 in medical costs and indirect costs, such as disability.
Every $10 bike helmet generates $570 in benefits to society.
Zhou, et al., 2005, Child Safety Network, 2005.
Slide15“I will prevent disease whenever I can, for prevention is preferable to cure.”
Hippocratic Oath (Modern Version)
Abraham Flexner, 1910
Slide16Strategies for Incorporating Prevention
Abraham Flexner, 1910
Slide17Collect preventive history information as part of your routine careOutpatientInpatientKnow what patients needReinforce prevention messages Then either arrange for it or refer to primary care!
Incorporating Prevention into the
Patient History
Slide18Typical Complete Medical InterviewChief complaint and History of Present illness
Past Medical History
Family History
Social HistoryPrevention (items not covered in other sections)Vital Signs and Physical ExamAssessment and Plan
Slide19Incorporate a Prevention History Past Medical History
Existing medical conditions (in numbered list format, including date of onset)
Major Hospitalizations (include dates)
Major surgical history (include dates)
Specific
female
screening for: mammogram, Pap smear, bone density (fractures, height loss)
Slide20Family health record (e.g. siblings, parents, and grandparents)age and health status
if deceased, cause of death
History of screening for diseases specific to known family history
Incorporate a Prevention History
Family History
Slide21Home/ HouseholdWork/educational history
Support systems
Cultural background
Travel history
Risk of TB or hepatitis exposure
Substance Use/Abuse
Diet/Physical activity habits
Safety Measures
Sexual history
Incorporate a Prevention History
Social History
Slide22Incorporate a Prevention History Additional prevention needs
Age-Appropriate Screenings
blood pressure
diabetes
lipids
colon cancer
depression
weight problems
sexually transmitted infections (STIs)
Immunizations
Influenza
pneumococcal
pertussis
tetanus
varicella
hepatitis A and B
MMR
meningococcal
HPV
receipt of BCG vaccine for TB in another country
Slide23Vital Signstemperatureheart rate
blood pressure
respiratory rate
Anthropometrics
height
weight
body mass index (BMI)
Incorporate a Prevention History
Physical Exam
Slide24Cancer and chronic disease screeningLifestyle/habitsSTIs/contraceptionImmunizationsIncorporate a Prevention History
Categories of Prevention Needs
Slide25Plan: Continue blood pressure medicine, educated re: low salt and low fat diet, exercise, and decrease alcohol
Encouraged smoking cessation
A
pply for medication assistance program
Prevention needs: Flu shot today; encouraged continued daily walking and decreasing fried foods; overdue for colon cancer screening- schedule colonoscopy.
Follow-up in 3 months
Incorporate a Prevention History
Example of a Patient Treatment Plan
Slide26Age-Specific Preventive History Cards
Abraham Flexner, 1910
Slide27Slide28Slide29Slide30Slide31Practice Cases56 year old man comes to the office for routine hypertension follow up21 year old man presents with a knee injury
28 year old woman in for consultation about
Lasik
surgery presents to Ophthalmology office
Slide32Practical TipsKnow your settingProvide recommendations accordinglyLook for “teachable moments”
Cover what you can; prioritize
You will not always have to do it all
Use office systems and staff to put routines in place
Electronic Health Records (EHR)
Make notes if you cannot cover it all
Document needs for future visits
Collaborate with colleagues across disciplines to incorporate prevention in a variety of settings
Slide33Additional ResourcesVideo demonstration of a patient history incorporating the prevention history components (available as a separate file for viewing)
Part B of this module – a slide set that covers evidence-based prevention and the US Preventive Services Task Force
A
pdf of the Age-Specific Preventive History Cards is available on the project website, or cards can be obtained through the Department of Public Health at the Brody School of Medicine
Slide34SummaryPrevention is a critical part of comprehensive, efficient and evidence-based care of all patientsAssessing a patient’s medical history should include age-appropriate preventionPatients prevention needs can be assessed in all medical settings and encounters
Tools and resources are available to assist medical providers
Slide35Collaborating InstitutionsCenter for Public Health Continuing Education University at Albany School of Public Health
Department of Community & Family Medicine
Duke University School of Medicine
Slide36Advisory CommitteeMike Barry, CAE
Lorrie Basnight, MD
Nancy Bennett, MD, MS
Ruth Gaare Bernheim, JD, MPH
Amber Berrian, MPH
James
Cawley
, MPH, PA-C
Jack Dillenberg, DDS, MPH
Kristine
Gebbie
, RN,
DrPH
Asim Jani, MD, MPH, FACP
Denise Koo, MD, MPH
Suzanne Lazorick, MD, MPH
Rika Maeshiro, MD, MPH
Dan Mareck, MD
Steve McCurdy, MD, MPH
Susan M. Meyer, PhD
Sallie
Rixey
, MD,
MEd
Nawraz Shawir, MBBS
Slide37APTRSharon Hull, MD, MPH President
Allison L. Lewis
Executive Director
O. Kent Nordvig, MEd
Project Representative