PREVENTIVE HEALTH CARE DANA BARTLETT, 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 of 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 Elsevire, Lippincott, and Thieme. He has written widely on the subject of toxicology and was recently named a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center and is actively involved in lecturing and mentoring nurses, emergency medical residents and pharmacy students. ABSTRACT Screening is an effective method for detecting and preventing acute and chronic diseases. In the United States healthcare tends to be provided after someone has become unwell and medical attention is sought. Poor health habits play a large part in the pathogenesis and progression of many common, chronic diseases. Conversely, healthy habits are very effective at preventing many diseases. The common causes of chronic disease and prevention are discussed with a primary focus on the role of health professionals to provide preventive healthcare and to educate patients to recognize risk factors and to avoid a chronic disease. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1 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. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 4 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology content is 0.5 hours (30 minutes). Statement of Learning Need Health professionals 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. Course Purpose To provide health clinicians with up-to-date knowledge of the current recommendations for preventive health screening tests and techniques, as well as recommendations in lifestyle changes that will promote preventive healthcare. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 2 Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Dana Bartlett, BSN, MSN, MA, CSPI, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 3 1. One of the limitations of screening tests is: a. Guidelines are often changed and updated. b. They rarely provide a high degree of specificity or sensitivity. c. They can only be used for adolescents 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 if they a. are males over age 35. b. drink hard liquor. c. use illicit drugs. d. engage in risky drinking behavior. 4. Breast cancer is a. only found in post-menopausal women. b. the second most common cancer in women. c. primarily caused by cigarette smoking. d. not detectable without a biopsy. 5. Breast cancer screening may include a. an x-ray. b. a CT scan. c. a biopsy. d. mammography and genetic testing. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 4 Introduction Screening is an effective method for detecting and preventing acute and chronic diseases. Instead, healthcare in the United States is typically provided after someone has become unwell. People generally seek a physician or medical attention when sick and not before. Additionally, poor health habits play a large part in the pathogenesis and progression of many common, chronic diseases. Often people view illnesses, such as atherosclerosis, diabetes, hypertension, or obesity, as acute and unexpected rather than conditions that can be prevented through screening and follow-up with their health clinician. Collaboration In Preventative Medicine In many cases, the signs and symptoms of chronic medical problems that cause morbidity and mortality in most Americans are just confirmation of an illness that has been present for many years. For example, approximately 34% of the adults in the U.S., are obese. Obesity is a major risk factor for the development of type 2 diabetes. The primary cause of obesity is harmful patterns of food intake and energy expenditure; too many calories and not enough exercise. Studies have clearly shown that type 2 diabetes can be prevented by weight loss, dietary changes, and exercise. Healthy habits are very effective at preventing many other diseases, as well. Preventative medicine involves a collaborative effort by the healthcare community and individual patients. These include the following local healthcare and individual efforts to promote health prevention. • The healthcare community identifies the diseases that affect, or are likely to affect a specific population. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 5 • The healthcare community screens for acute and chronic health problems and identifies people at risk. • The healthcare community delivers specific interventions and therapies that will prevent disease, i.e., vaccinations. • The healthcare community provides consumers with information about behaviors and interventions that can help prevent chronic illness. • The healthcare community supports consumers in a life-long commitment to healthy life style choices • The individual makes the changes in diet, exercise, and other life style factors that influence his/her health. Screening For Disease Detection And Prevention Screening is an effective method for detecting and preventing acute and chronic diseases. However, it is important to remember the following points when broad screening guidelines are used for a heterogeneous population. • Not all cases of disease can or will be detected. • Screening guidelines are always being changed and updated. • Screening should be done on a case-by-case basis and when appropriate, screening should be accompanied by an examination and interview with a healthcare professional. • A screening test is not a diagnostic test. In addition, screening is most effective when a disease or disorder 1) is an important public health problem, 2) has an early, asymptomatic phase, 3) has an effective screening test that can accurately identify people who will benefit from treatment, 4) has an nursece4less.com nursece4less.com nursece4less.com nursece4less.com 6 available treatment, and 5) involves screening tests with benefits that outweigh the risks. Screening tests should be simple to perform, cost- effective, and easy to interpret and they must be sensitive and specific. The primary source of information used in this learning module is the U.S. Preventive Services Task Force’s (USPSTF) Guide to Clinical Preventive Services 2014. The USPSTF Guide discusses many diseases and disorders. This module will for the most part only discuss ones for which the Guide provides screening recommendations but some exceptions have been made. The Guide to Clinical Preventive Services 2014 is available online.1 Alcohol Use Disorder And Addiction The unhealthy use of alcohol by Americans is endemic. The 2014 National Survey on Drug Use and Health noted that 60.9 million Americans reported binge alcohol use in the past month and 16.3 million reported heavy drinking in the past month.2 Over 17 million American adults have an alcohol use disorder, and the twelve-month and lifetime prevalence of alcohol use disorder has been estimated to be 13.9% and 29.1%, respectively.3 The unhealthy use of alcohol is often unrecognized in the primary care setting and studies support screening of the population for unhealthy alcohol use.4 Who should be screened for alcohol use, when people should be screened, and how often screening should be done depends on factors such as age and an individual’s experience with alcohol and/or drugs; and, different screening guidelines are available. The USPSTF recommendations are shown below.5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com 7 USPSTF Recommendations for Screening for Alcohol Misuse Screen for alcohol misuse and provide brief behavioral counseling interventions to persons engaged in risky or hazardous drinking. There is a moderate net benefit to alcohol misuse screening and brief behavioral counseling