2010 Preventive Care Guidelines

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Mercer is pleased to provide you with the 2010 Preventive Care Guidelines, which reflect the newly enacted Patient Protection and Affordable Care Act (PPACA). This document shows the USPSTF A and USPSTF B recommendations for preventive care. Many of these recommendations are focused on prevention and counseling and will not be identified in the medical claims or be part of a plan design.

Our guidelines can help consultants and employers to understand preventive services, create plan designs and offerings, and work with the carriers to create the tools to imple-ment and measure preventive care services.

Screening (all adults)

Preventive visit and counseling are recommended every 3–5 years for women and every 5 years for men until they reach age 65; after that every 1–2 years. 2

High blood pressure screening should begin at age 18 and continue every two years if below 120/80, or every year if between 120 and 139 systolic or 80 to 90 diastolic. 1, 2

Total cholesterol and HDL screening should begin at age 35 for men and 45 for women and continue every five years (shorter intervals if lipid levels close to warranting therapy, longer intervals if lipid levels are low or repeatedly normal). For those in the higher risk group, screening should start at age 20 to 35 if male, or 20 to 45 if female. 1

Colorectal cancer screening should be carried out between age 50 and 80, or 45 and 80 for African Americans, at appropriate intervals for screening method chosen: flexible sigmoidoscopy every five years, colonoscopy every 10 years, double-contrast barium enema every five years, 1, 2 ,3 or CT colonography (virtual colonoscopy) every five years. 2 ,3

Diabetes screening should be given to all asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg. 1

Syphilis screening should be carried out if patient is at an increased risk; clinical judgment should be used as to frequency. 1, 2

HIV screening should be done at any age if patient is at an increased risk; optimal frequency has not been determined. 1

Screening (men only)

Abdominal aortic aneurysm screening is recommended at age 65–74; if patient is at risk, he should receive a one-time ultrasound screening. 1, 2

Prostate cancer: Prostate-specific antigen (PSA) and/or digital rectal exam (DRE): Beginning in 2009, the USPSTF no longer recommended routine PSA testing for men over 50. At this time, clinicians should discuss the potential harms and benefits of PSA/DRE screening with patients younger than 75 years of age, after which the patient and provider can come to a mutually acceptable agreement on whether to screen. 2 The discussion about screening should take place at age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years. 3 Many employers are still covering PSA as a preventive screen.

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Screening (women only)

Mammography: Yearly mammograms are recom-mended starting at age 40 and continuing for as long as a woman is in good health. 3

Cervical cancer screening should begin after onset of sexual activity or age 21, whichever comes first, and continue every three years. Where a Pap test has been abnormal, screen annually until three consecutive normal Pap smears, then every 3 years. 1, 2, 3 Women age 70 or older who have had three or more normal Pap test results in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer testing. 3

Chlamydia screening should be carried out for all sexually active women age 24 and under and women at high risk. 1, 2

Gonorrhea screening should be carried out for all sexually active women, including those pregnant, if at increased risk. 1

Osteoporosis: for patients at increased risk, screening should begin at age 60 1 and continue every two years until age 85. 1

Pregnant women

At first prenatal visit, women should be screened for hepatitis B, 1 syphilis (for high risk groups, 1 testing should be repeated in third trimester and at delivery) and Rh (D) incompatibility. 1

HIV testing should be offered as a standard part of prenatal care – unless declined 1 – and gonorrhea screening should be carried out if patient is at increased risk. In addition, at 12–16 weeks’ gestation, 1 women should be screened for asymptomatic bacteriuria; and asymptomatic women should be screened for iron deficiency.

Additional counseling services

USPSTF grade A recommendations

1. Clinicians should ask all adults about tobacco use and provide counseling on tobacco cessation interventions. Also, all pregnant women should be informed about tobacco use and smokers should be provided with augmented, pregnancy-tailored counseling.

2. The use of aspirin should be recommended for men age 45 to 79 years (when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastroin-testinal hemorrhage) and for women age 55 to 79 years (when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage).

3. All women planning or capable of pregnancy should take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid.

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USPSTF grade B recommendations

1. Dietary counseling is recommended for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease.

2. All adult patients should be screened for obesity and offered intensive counseling and behavioral interventions.

3. Screening and behavioral counseling interventions should be available to reduce alcohol misuse by adults.

4. Adults should be screened for depression.

5. Genetic counseling and evaluation for BRCA testing should be available to women with family history of mutations in BRCA1 or BRCA2 genes.

6. Interventions are recommended during pregnancy and after birth to promote and support breastfeeding.

Hepatitis A Only those at risk. 2, 4

Hepatitis B Administer or complete a 3-dose series of HepB to those persons not previously vaccinated.

Human Papillomavirus (HPV) Three doses for females through starting from age 11 to 26.4 Males age 9 to 26 may receive the injection to reduce their likelihood of acquiring genital warts. 4

Influenza (flu) Annual for all persons who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others or for adults at risk. 2, 4

MMR (measles, mumps, rubella) Born in 1957 or later, at least one dose of MMR unless history of prior vaccination or evidence of immunity. Second dose 4 weeks after the first is recommended if at risk. 4

Meningococcal One or more doses at any age.

Pneumococcal vaccine (PPSV) Once for adults with risk factors. Booster after 5 years for adults at highest risk and those most likely to lose their immunity. 2, 4

Tetanus, diphtheria, pertussis (Td/Tdap) One-time dose of Tdap for Td booster; then booster every 10 years. 2, 4

Tuberculosis (TB) For individuals in high risk group that may have been exposed. 4 Annually for health care workers. 4

Varicella (chickenpox) For adults without evidence of immunity, two doses of varicella vaccine should be given, unless the individual already received on injection. The first is followed by a second dose at an interval of at least 28 days. A catch-up second dose should be given to all children, adolescents and adults who received only one dose previously. 2, 4

Zoster One dose for all adults age 60 and over. 4

Immunizations (adults)

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Pediatric Preventive Services – Detailed guidelines

USPSTF grade A recommendations

Newborn screening is recommended for congenital hypothyroidism, phenylketonuria (PKU) and sickle cell disease.

USPSTF grade B recommendations

1. Screening for hearing loss in all newborn infants.

2. Prevention of dental caries in preschool children: Primary care clinicians prescribe oral fluoride supplementation at currently recommended doses to preschool children older than 6 months whose primary water source is deficient in fluoride.

3. Visual impairment: screening to detect amblyopia, strabismus, and defects in visual acuity in children younger than age 5.

4. Screening and treatment for major depressive disorder in adolescents.

In conclusion

With the enactment of health care reform, there has been more emphasis on preventive care services. While employers have been providing preventive care for their employees for many years, this new legislation has changed some employers’ and carriers’ approaches to preventive services altogether. The newly released Mercer Preventive Care Guidelines will enable consul-tants, their clients, and employees to understand what services are included under the new law and what preventive care is appropriate for a specific age.

Sources1 US Preventive Services Task Force (USPSTF). Guide to Clinical

Preventive Services, 2010-2011, available at: http://www.ahrq.gov/clinic/pocketgd1011/

2 Institute for Clinical Systems Improvement (ICSI). Preventive Services for Adults, Fifteenth Edition/October 2009, available at: www.icsi.org/preventive services for adults/preventive services for adults 4.html

3 American Cancer Society (ACS). Prevention and Early Detection, available at: www.cancer.org/docroot/PED/PED_0.asp

4 Recommended Adult Immunization Schedule – United States, 2010, available at: www.cdc.gov/mmwr/PDF/wk/mm5901-Immunization.pdf

Immunizations (children)

n Diphtheria, tetanus, pertussis (DTaP or Tdap)

n Haemophilus influenza type b (Hib)

n Hepatitis A

n Hepatitis B

n Human papillomavirus (HPV) (beginning at age 9 for boys and 11girls, with completion of the three doses no later than age 26)

n Inactivated poliovirus (IPV)

n Influenza (yearly)

n Measles, mumps, rubella (MMR)

n Meningococcal

n Pneumococcus (PCV or PPSV)

n Rotavirus

n Varicella

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