Preventive Care Guidelines

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Preventive Care Guidelines

"How often should I visit my doctor?"

It's a question asked often by healthy adults. The Preventive Health Care Guidelines have been prepared by Sutter Health physicians to help you understand the need to schedule preventive medical care. The guidelines are grouped by age, for your convenience.

Birth - 18 Years

Health Maintenance Evaluation
A regularly scheduled Health Maintenance Evaluation at each of the following ages:

1, 2, 4, 6, 9, 12 and 18 months
2 and 3 years
5, 7 and 10 years
13 and 16 years
18 years

Tuberculosis skin test is optional* at 12 months, 5 years, and at 15 years.

Immunizations/Vaccinations
The following immunizations should be given between birth and 18 years. As different vaccine schedules are required depending upon the vaccine product and type your group uses, consult your pediatrician or family physician for the best schedule for your child:

Hepatitis B
HIB—combination vaccination for Diphtheria, Pertussis, Tetanus and Hemophilus
MMR—Measles, Mumps and Rubella
DTaP—Diphtheria, Tetanus and acellular Pertussis
Td—Adult Diphtheria and Tetanus
Chicken pox (Varicella)
Polio

Pap Smear
At 18 years of age, a woman should begin to have yearly pap smears at her annual health check-ups.
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19 to 39 Years

Health Maintenance Evaluation
Every five years

Women's Health
Pap Smear - At least every three years
Estrogen replacement therapy, contraception or pregnancy will alter these recommendations. An abnormal Pap smear, multiple sexual partners, or history of sexually transmitted disease require more frequent evaluations.

Immunizations/Vaccinations
Tetanus-diphtheria - Booster every 10 years

Laboratory Testing
Cholesterol - Men begin at 35
These guidelines do not pertain to patients on chronic medications, including birth control, estrogen replacement therapy, or patients with personal or family health risks.
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40 to 49 Years

Health Maintenance Evaluation
Every two years

Women's Health

Pap Smear - At least every three years
An abnormal pap smear, multiple sexual partners, or history of sexually transmitted disease require more frequent evaluations.
Mammogram - Every 1-2 years, starting at 40

Laboratory Testing
Cholesterol - Every five years
Men begin at 35, Women begin at 45

Immunizations/Vaccinations
Tetanus-diphtheria - Booster every 10 years
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50 to 64 Years

Health Maintenance Evaluation
Annually

Sigmoidoscopy - At least every 10 years- *optional every five years
Fecal Occult Blood - Annually

Women's Health

Pap Smear - At least every three years. An abnormal pap smear, multiple sexual partners, or history of sexually transmitted disease require more frequent evaluations.
Mammogram - Every 1-2 years

Laboratory Testing
Cholesterol - Every five years
PSA (for men) - *Optional annually

Immunizations/Vaccinations
Tetanus-diphtheria - Booster every 10 years

Optional recommendations have not been confirmed to be beneficial in long-term case-controlled studies but are recommended by at least one or more professional organization.
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65 & Over

Health Maintenance Evaluation
Annually

Sigmoidoscopy - At least every 10 years until age 70, *optional every five years,*optional after age 70
Fecal Occult Blood - Annually

Women's Health

Pap Smear - **Optional every three years until age 70 An abnormal pap smear, multiple sexual partners, or history of sexually transmitted disease require more frequent evaluations.
Mammogram (for women) - Every 1-2 years until age 70

Laboratory Testing

Cholesterol - Every five years until age 65 then - *optional
PSA (for men) - *Optional annually until 70

Immunizations/Vaccinations

Tetanus-diphtheria - Booster every 10 years until age 70
Influenza - Annually
Pneumococcal - at age 65

**Screening is discretionary after age indicated. Discuss risks & benefits of screening with your primary care provider.
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Definition of Terms

Health Maintenance Evaluation: A visit to your health care provider which includes a discussion of your present medical concerns, a review of your medical history, a physical examination, to include at least blood pressure and weight, and the ordering of appropriate laboratory testing. Your physician may choose to perform your health maintenance examination during a problem-oriented visit.

Pap Smear: A screen for cancer of the cervix done in conjunction with an internal pelvic examination in women. At the physician's discretion after three normal exams, frequency may be reduced to every three years. More information regarding Pap Smear may be foundhere.

Fecal Occult Blood: Examination for small amounts of blood in the stool which may be associated with increased risk for colon cancer. Read more about the Fecal Occult blood test here.

Cholesterol: A blood study for detecting elevated blood levels of fats associated with risk of heart disease and stroke. Men may begin screening at age 35. Both men and women should have a cholesterol check at 45. Read more about cholesterol testing here.

PSA: (Prostrate Specific Antigen) A blood test for the early detection of possible prostrate cancer in men. Read more about PSA here.

Mammogram: A screening for early detection of breast cancer. Read more about Mammography here.

Sigmoidoscopy: A fiberoptic view of the sigmoid colon for the detection of colon polyps or early detection of colon cancer. Read more about Sigmoidoscopy here.

References

References and supporting literature:

American Academy of Family Physicians. Clinician's Handbook of Preventive Services. U.S. Public Health Services; 1994.
Case-Control Study of Screening Sigmoidoscopy and Mortality from Colorectal Cancer. Selby, J. NEJM 1992; 326:653-7.
Efficacy of Screening Mammography. Kerlikowski, K. JAMA. 1995; 273:149-154.
Screening for Colorectal Cancer. Toribara, N. NEJM 1995; 332:861-867.
Screening for Cervical Cancer. Eddy, D. Annals of Internal Medicine 1990; 113:214-226.
Screening for Prostate Cancer. Krahn, M. JAMA. 1994; 272:773-780. U.S Preventive Services Task Force. Guide to Clinical Preventive Services. Baltimore, Md: Williams & Wilkins, 1996.
Health Promotion and Disease Prevention in Clinical Practice. Baltimore, Md: Williams & Wilkins, 1996.
Colorectal Cancer Screening Clinical Guidelines. Rational Winawer, S. et al. Gastroenterology 1997;112:594-642.

Recommended reading:

Healthwise Handbook. Donald W. Kemper, Healthwise, Inc.
Caring for Your Baby and Young Child. The American Academy of Pediatrics.
Take Care of Yourself. By Vickery & Fries.
Taking Care of Your Child. By Pantell, Vickery & Fries.
Living Well. Taking Care of Your Health in the Middle and Later Years. By Fries.
Cuidate: Guia para una mejor atencion medica. By Vickery & Fries.

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