Clinical Preventive services

Background
People with existing chronic diseases such as SCD may fail to receive some of the recommended clinical preventive services because they and their health care physicians are focused on controlling and preventing problems from SCD and its related complications or other comorbid chronic diseases. Unfortunately, this primary focus on SCD may result in people developing other health problems that could have been prevented or treated at an earlier stage, when complications are less frequent. With this situation in mind, the expert panel has identified important recommendations from the USPSTF that should be followed in the care of newborns, children, adolescents, and adults with SCD.

The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care clinicians (such as intemists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services and develops recommendations for the general population in the United States. These recommendations are published in the form of “Recommendation Statements.” The recommendations are aimed at the prevention and early recognition of chronic disease.

We have included only the strong recommendations with high-level evidence from the USPSTF and therefore will not address the strength of recommendation or evidence for each of the recommendations listed in exhibit 5. (Please note that these include grade A and B recommendations from the USPSTF. For more information, see http://USPreventiveServieesTaskForce.org.) These general clinical preventive services should be provided to the person with SCD within the patient’s principal health care site. This could be a primary care provider, a sickle cell specialist, or, in many instances, both working together and communicating with one another.

Recommendations of the USPSTF are updated on an ongoing basis. Health care professionals are encouraged to view the most up-to-date recommendations at any time by visiting either http://USPrevcntivcScrviccsTaskEorce.org or by utilizing the searchable and downloadable electronic
Preventive Services Selector (ePSS) available at http://www.cPSS.ahrq.Nov.

The following should be available to all newboms:
• SCD screening with clinical consideration of confirmatory test within 2 months
• Hypothyroidism screening (primary TSH with T4 backup or primary T4 with TSH backup)
• Hearing loss screening
• Phenylketonuria (PKU) screening
• Prophylactic ocular topical medication for the prevention of gonococcal ophthalmia neonatorum
• Counseling for pregnant women regarding the advantages of breastfeeding (The expert panel notes that current maternal use of hydroxyurea is a contraindication to breastfeeding.)

All children (aged 3 months to 12 years or as stated) should have:
• Fluoride supplement in those over 6 months of age whose water supply is deficient in guoride
• Routine iron supplementation for asymptomatic infants aged 6 months to 12 months who are at increased risk for iron deficiency anemia
• Children aged 3 to 5 should receive routine evaluation for amblyopia, strabismus, and defects in visual acuity using visual acuity test, stereoacuity test, cover-uncover test, Hirschberq light reflex test, autorefraction and/or photoscreening.
• Children aged 6 years and older should be screened for obesity. Offer or refer for intensive counseling and behavioral interventions.
• The USPSTF recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection.

All adolescents (aged 12 to 18 years) should be assessed and offered:
• HIV screening for all sexually active adolescents 15 years of age and older and for younger teens who are at high risk
• Screen for chlamydial infection for all sexually active nonpregnant women aged 24 and younger
• Screen for gonorrhea infection in all sexually active girls at high risk for infection
• The USPSTF recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection.
• Offer high intensity behavior counseling to prevent sexually transmitted infections (STIs) for all sexually active adolescents at increased nsk for STIs.
• Provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents (Grade B recommendation)
• Depression screening when systems for diagnosis, treatment, and followup are in place
• Counsel children, adolescents, and young adults aged 10 to 24 years who have fair skin about minimizing their exposure to ultraviolet radiation to reduce risk for skin cancer.
• Screen all teens for obesity and refer obese teens for comprehensive, intensive behavioral interventions

Offer all adults:
• Hepatitis C virus screening if
At high risk for infection (e.g., those with multiple transfusions) Bonn between 1945 and 1965 (offer one-time screening)
• Tobacco use screening and counseling (all adults, repeat at each visit for those who are smoking)
• Screening and behavioral counseling interventions to reduce alcohol misuse
• Screen all adults for obesity, and offer or refer patients with a body mass index of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions.
• Screen for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years; an option for women 30 to 65 is a combination of cytology and human papillomavirus (HPV) testing every 5 years
• HIV screening (offer to all and repeatedly offer to high-risk people)
• Hepatitis B screening (for those on transfusion therapy)
• Assess risk for breast cancer and offer to prescribe risk-reducing medications, if appropriate, for women at increased risk
• Breast screening mammography for women aged 50 to 74 years
• Women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes should be referred for genetic counseling and, if indicated after counseling, BRCA testing.
• Chlamydial infection screening for all sexually active women *24, and for older women at high risk
• Folic acid supplementation should be used whenever considering or at risk of pregnancy to prevent neural tube defecb.
• Cardiovascular disease risk screening
Diabetes screening for people with hypertension
Lipids: Screen men ages 25 to 35 at high risk and all men >’35 years. Screen women 20 years or older who are at high risk
Screen for high blood pressure in adults aged 18 and older(For blood pressure screening recommendations, see page 18)
• Screen adults for colon cancer beginning at age 50 and continuing until age 75
• Depression screening when staff assisted support in place for diagnosis, treatment, and followup
• Osteoporosis screening for women ñ65 years. For women younger than 65 years, screen those whose fracture risk is equivalent or higher to a 65-year-old White woman.
• Sexually transmitted infection counseling for all sexually active adults at high risk
• Gonorrhea screening for sexually active women <25 and others at high risk • One-time ultrasound abdominal aortic aneurysm screening for men who have smoked and are 65 to 75 years old Offer all pregnant women: • Bacteriuria screening (asymptomatic) • Gonorrhea screening for women <25 years old and for older women at high risk • Hepatitis B screening • HIV screening • Syphilis screening • Chlamydial screening for all pregnant women aged 24 and younger and for older pregnant women who are at increased risk • Rh compatibility screening