PREVENTIVE HEALTH CARE DANA BARTLETT, RN, BSN, MSN, MA, CSPI Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 20 years as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material, written textbook chapters, and done editing and reviewing for publishers such as Elsevier, Lippincott, and Thieme. He has written widely about toxicology and was a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center. NOAH CARPENTER, MD Dr. Noah Carpenter is a Thoracic and Peripheral Vascular Surgeon. He completed his Bachelor of Science in Chemistry and medical school and training at the University of Manitoba. Dr. Carpenter completed surgical residency and fellowship at the University of Edmonton and Affiliated Hospitals in Edmonton, Alberta, and an additional Adult Cardiovascular and Thoracic Surgery fellowship at the University of Edinburgh, Scotland. He has specialized in microsurgical techniques, vascular endoscopy, laser and laparoscopic surgery in Brandon, Manitoba and Vancouver, British Columbia, Canada and in Colorado, Texas, and California. Dr. Carpenter has an Honorary Doctorate of Law from the University of Calgary, and was appointed a Citizen Ambassador to China, and has served as a member of tPreventive Health Carehe Native Physicians Association of Canada, the Canadian College of Health Service Executives, the Science Institute of the Northwest Territories, the Canada Science Council, and the International Society of Endovascular Surgeons, among others. He has been an inspiration to youth, motivating them to understand the importance of achieving higher education. ABSTRACT Health prevention programs that involve annual physical evaluations and screening is an accepted method to effectively reduce the incidence and negative impact of common diseases. In the United States, research has focused on initiatives to improve community-based programs to increase healthy lifestyles throughout all age groups. New strategies to promote healthier populations must consider prior barriers to preventive healthcare and environmental influences that impact the risk and outcome of a disease state. By developing a solid understanding of health prevention, enhanced strategies to improve health outcomes may be reached by health teams that support healthier populations in U.S. regions and worldwide. 1 NurseCe4Less.com Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. Continuing Education Credit Designation This educational activity is credited for 5 hours at completion of the activity. Pharmacology content is 0.5 hours (30 minutes). Statement of Learning Need Health professionals worldwide need to know the recommended screening tests that may lead to early detection or prevention of medical problems that cause morbidity and mortality if left undiagnosed and untreated. Strategies across geographic and national boundaries are continuously developing with a high focus on social, economic, environmental and health factors that are linked and correlate with patterns of disease. Healthy populations require that health prevention research and policies move beyond a “one size fits all” and that interdisciplinary health teams remain knowledgeable about standard health screening guidelines and prevention throughout the lifespan. Course Purpose To provide members of the interdisciplinary health team with knowledge of the current recommendations for preventive health screening tests and techniques, as well as of the recommendations lifestyle changes that will promote a healthy population. Target Audience Advanced Practice Registered Nurses, Registered Nurses, and other Interdisciplinary Health Team Members. Disclosures Dana Bartlett, RN, BSN, MSN, MA, CSPI, Noah Carpenter, MD, Kellie Wilson, PharmD, William Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures. There is no commercial support. 2 NurseCe4Less.com Self-Assessment of Knowledge Pre-Test: 1. One of the limitations of screening tests is a. screening guidelines are often changed and updated. b. these tests rarely provide a high degree of specificity or sensitivity. c. the guidelines differ for children and adults. d. the benefits seldom outweigh the risks. 2. Screening tests must be used with the understanding that a. they are seldom able to detect diseases. b. most of them are associated with harmful side effects. c. they are not diagnostic. d. they cannot be used for children. 3. Adults should be screened for alcohol misuse a. unless the patient is pregnant. b. only if they use illicit drugs. c. only if they engage in risky drinking behavior. d. in all cases. 4. Breast cancer is a. more common in women < 50 years of age. b. the most common cancer in women. c. primarily caused by cigarette smoking. d. not detectable without a biopsy. 5. What is the recommendation of the U.S. Preventive Services Task Force (USPSTF) regarding the use of mammograms to screen for breast cancer in women age 75 or older? a. They should have a mammogram annually. b. The USPSTF recommends against a mammogram in all cases. c. They should have a biennial mammogram. d. There is no recommendation. 3 NurseCe4Less.com Introduction Preventative healthcare involves disease identification in specific at-risk populations, and preventive health programs typically include an interdisciplinary health team that is knowledgeable of screening guidelines for acute and chronic health conditions. Health prevention strategies should aim at the delivery of specific interventions and therapies to reduce the chance of developing a chronic disease, and the promotion of successful health outcomes through strong patient engagement. A primary role of all health professionals is to educate patients about health prevention and screening practices, and to raise awareness of how poor health habits can lead to the development of many common, chronic diseases. Good health prevention education promotes awareness in individuals and communities about needed changes to health behaviors to help avoid disease through a lifelong commitment to healthy lifestyle choices. Screening for Disease Detection and Prevention Screening tests are done to detect potential health disorders or diseases in a patient who does not have symptoms of a health condition. Screening tests are not considered diagnostic but they are used to identify a group of the population who should be tested to determine the presence or absence of disease. Through early detection, a patient may be made aware of the potential disorder or disease and make lifestyle changes to address it. The patient may also receive regular monitoring and treatment to reduce the risk of disease.1 The goal with screening for disease is to prevent chronic medical problems that often result in increased morbidity and mortality. Poor dietary choices, lack of exercise and obesity has been identified as a major risk factor for the development of multiple health problems, including metabolic disease, heart disease and cancer.1,2 Harmful patterns of food intake, such as those dense in sugar, saturated fat, and poor portion control, and not enough exercise have been studied and reported to have a direct correlation with the incidence of chronic disease.1,2 4 NurseCe4Less.com Annual health screening is an effective method for detecting and preventing poor health habits that cause acute and chronic diseases. Although broad screening guidelines are often a helpful start to discussing personal health choices, in a heterogeneous population the use of screening guidelines are not likely to detect all cases of disease. Screening guidelines are continuously evolving and being updated, so screening on a case-by-case basis is recommended. When appropriate, screening should be accompanied by a physical examination and patient interview with a health professional. Health screening is most beneficial when a disease is known to be an important public health problem. A screening examination has the best outcome when completed during an early, asymptomatic phase of a disease and after identifying people who may benefit from treatment.1,2 Also, treatment that is readily available and where the benefits of treatment outweigh health risks generally yield improved outcomes. In general, screening tests should be simple to perform, cost-effective, easy to interpret and they must be sensitive and specific to the disease being screened. Alcohol Use Disorder The unhealthy use of alcohol by Americans is endemic. The 2015 National Survey on Drug Use and Health noted that 24.9% of Americans reported binge alcohol use in the past month and 6.9% reported heavy drinking in the past month.3 Almost three of every 10 Americans uses alcohol in an unhealthy way, and 14% met the criteria for alcohol use disorder.3 The unhealthy use of alcohol may go unrecognized in the primary care setting and studies have supported screening of the population for unhealthy alcohol use.4 How often and who should be screened for alcohol use depends on several factors, such as age and an individual’s experience with alcohol and/or drug use. Different screening guidelines are available, and the U.S. Preventive Services