1. health and fitness
2. disease
3. cancer

To:
CoventryCares of Kentucky Providers
From: CoventryCares of Kentucky Provider Relations
Date: June 7, 2013
RE:
2013 PREVENTIVE HEALTH GUIDELINES
CoventryCares of Kentucky (CoventryCares) has posted the 2013 Preventive Health Guidelines
for all ages on the CoventryCares web site located at www.coventrycaresky.com under the ‘For
Providers’ tab, ‘Clinical Practice Guidelines’.
The CoventryCares 2013 Preventive Health Guidelines includes a review of the 2012/2013 updates
to the U.S. Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services, in
addition to other recognized guidelines/recommendations compared to Coventry’s 2012 Preventive
Health Guidelines. The 2013 review is inclusive of recommendations of the Affordable Care Act of
2010, comprising previous USPSTF updates with an A, B, C or D recommendation, in addition to
guidelines supported by the U.S. Department of Health Resources and Services Administration
(HRSA) developed by the American Academy of Pediatrics.
Please note, these preventive health guidelines are to be used to assist in decision-making and
provide guidance in patient care. However, healthcare professionals should always use sound
clinical judgment and apply individualized plans of patient care when appropriate.
The review is performed annually during the first quarter of the year. Full details on the
recommendations can be found in Appendix A (USPSTF), Appendix B (Alternate Sources), and
Appendix C (HRSA).
Appendix A:
All USPSTF Recommendations reviewed for consideration:
Cervical Dysplasia Screening and Cervical cancer screening [Listed on Guideline as
Papanicolaou (Pap) Test (Women)]
Recommendation: These recommendations apply to women who have a cervix, regardless
of sexual history. These recommendations do not apply to women who have received a
diagnosis of a high-grade precancerous cervical lesion or cervical cancer, women with in
utero exposure to diethylstilbestrol, or women who are immunocompromised (such as those
who are HIV positive).
The USPSTF recommends screening for cervical cancer in women ages 21 to 65
years with cytology (Pap smear) every 3 years or, for women ages 30 to 65 years who
want to lengthen the screening interval, screening with a combination of cytology and
human papillomavirus (HPV) testing every 5 years.
Grade: A Recommendation.
The USPSTF recommends against screening for cervical cancer in women younger
than age 21 years.
Grade: D Recommendation.
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The USPSTF recommends against screening for cervical cancer in women older than
age 65 years who have had adequate prior screening and are not otherwise at high risk
for cervical cancer.
Grade: D Recommendation.
The USPSTF recommends against screening for cervical cancer in women who have
had a hysterectomy with removal of the cervix and who do not have a history of a highgrade precancerous lesion (i.e., cervical intraepithelial neoplasia [CIN] grade 2 or 3) or
cervical cancer.
Grade: D Recommendation.
The USPSTF recommends against screening for cervical cancer with HPV testing,
alone or in combination with cytology, in women younger than age 30 years.
Grade: D Recommendation.
HIV Screening:
Recommendation:
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that
clinicians screen for human immunodeficiency virus (HIV) all adolescents and adults at
increased risk for HIV infection.
Grade: A Recommendation.
The USPSTF makes no recommendation for or against routinely screening for HIV
adolescents and adults who are not at increased risk for HIV infection.
Grade: C Recommendation.
Obesity screening and counseling: adults (Listed on Guidelines as Assess for Obesity):
Recommendation:
The USPSTF recommends screening all adults for obesity. Clinicians should offer or refer
patients with a body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent
behavioral interventions.
Grade: B Recommendation
Screening and counseling for interpersonal and domestic violence:
Recommendation remains:
The USPSTF recommends that clinicians screen women of childbearing age for
intimate partner violence, such as domestic violence, and provide or refer women who
screen positive to intervention services.
Grade: B Recommendation.
The USPSTF concludes that the current evidence is insufficient to assess the balance
of benefits and harms of screening all elderly or vulnerable adults (physically or
mentally dysfunctional) for abuse and neglect.
Grade: I Statement.
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STIs Counseling:
Recommendation remains:
The USPSTF recommends high-intensity behavioral counseling to prevent sexually
transmitted infections (STIs) for all sexually active adolescents and for adults at
increased risk for STIs.
Grade: B Recommendation.
The USPSTF concludes that the current evidence is insufficient to assess the balance
of benefits and harms of behavioral counseling to prevent STIs in non-sexually-active
adolescents and in adults not at increased risk for STIs.
Grade: I Statement.
Fall prevention in Community- Dwelling older Adults:
Recommendation:
The USPSTF recommends exercise or physical therapy and vitamin D
supplementation to prevent falls in community-dwelling adults aged 65 years or older
who are at increased risk for falls.
Grade: B Recommendation.
The USPSTF does not recommend automatically performing an in-depth multifactorial
risk assessment in conjunction with comprehensive management of identified risks to
prevent falls in community-dwelling adults aged 65 years or older because the
likelihood of benefit is small. In determining whether this service is appropriate in
individual cases, patients and clinicians should consider the balance of benefits and
harms on the basis of the circumstances of prior falls, comorbid medical conditions, and
patient values.
Grade: C Recommendation
Skin Cancer Counseling:
Recommendation:
The USPSTF recommends counseling 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.
Grade: B Recommendation.
The USPSTF concludes that the current evidence is insufficient to assess the balance
of benefits and harms of counseling adults older than age 24 years about minimizing
risks to prevent skin cancer.
Grade: I Statement.
Appendix B:
Alternate Sources:
Screening for Aneuploidy (extra or missing Chromosome (ACOG:2007):
Recommendation:
Screening and invasive diagnostic testing for aneuploidy (extra or missing chromosome)
should be available to all women who present for prenatal care before 20 weeks of gestation
regardless of maternal age. Women should be counseled regarding the differences between
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screening and invasive diagnostic testing. The choice of screening test depends on many
factors, including gestational age at first prenatal visit, number of fetuses, previous obstetric
history, family history, availability of nuchal translucency measurement, test sensitivity and
limitations, risk of invasive diagnostic procedures, desire for early test results, and options for
earlier termination.
Dental Health (AA:2008):
Recommendation:
Counsel for properly fitted mouth guards for youths involved in sporting activities that carry
risk of oral facial injury.
Injury prevention alcohol (ICSI:2012):
Recommendation:
7-12 Years • Reinforce alcohol abuse prevention and education.
13+ Years • Don't ride with someone who is under the influence of alcohol ; Prevent others
from driving in this condition: "Friends don't let friends drive drunk." ; Reinforce not drinking
and driving, and the dangers of it; Abstinence if driving
Adult: Have a designated driver; Discuss characteristics of dependency; advise all females of
childbearing age of the harmful effects of alcohol on a fetus and the need for cessation
during pregnancy; Reinforce not drinking and driving; Advise patients to not ride with
someone under the influence of alcohol and to prevent him or her from driving.
There is no evidence-based information, but it is unlikely that simple counseling messages
will suffice, so when individuals with problems due to their drug use are found, the primary
aim here should be to refer patients with this problem to specialized treatment programs.
Injury Prevention Hand guns (AAP:2007):
Recommendation remains:
Keep handguns out of places where children live and play. If parents choose to keep a
firearm in the home, the unloaded gun and ammunition must be kept in separate locked
cabinets
Injury Prevention – Burn (AAP:2009):
Recommendation remains:
Hot-water temperature should be set at a maximum of 120°F to avoid scald burns. Parents
should be advised not to carry their infant and hot liquids or foods at the same time. Milk and
formula should not be heated in the microwave because it can heat unevenly, causing
pockets of liquid hot enough to scald the infant’s mouth. Electrical outlets should be covered
with devices that will not pose a choking hazard.
Smoke alarms in the home should be installed and maintained.
Appendix C:
HRSA Recommendations (Affordable Care Act):
HIV screening:
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Recommendation remains; Counseling and screening for HIV infection for all sexually active women
annually
Human papillomavirus testing:
Recommendation remains:
High-risk human papillomavirus DNA testing in women with normal cytology results.
Screening should begin at 30 years of age and should occur no more frequently than every 3
years.
Screening and counseling for interpersonal and domestic violence:
Recommendation remains:
Screening and counseling for interpersonal and domestic violence annually.
Well Woman Visit:
Recommendation Remains:
Well-woman preventive care visit annually for adult women to obtain the recommended
preventive services that are age and developmentally appropriate, including
preconception and prenatal care. This well-woman visit should, where appropriate,
include other preventive services. Annual, although HHS recognizes that several visits
may be needed to obtain all necessary recommended preventive services, depending
on a woman’s health status, health needs, and other risk factors.
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