BLUECROSS BLUESHIELD’S 2001 PREVENTIVE SERVICES GUIDELINES FOR ADULTS

These recommendations are for asymptomatic adults and do not indicate an exclusive course of treatment. Variations, taking into account individual circumstances, may be appropriate.

PERIODIC HEALTH EVALUATIONS	21-39 YEARS	40-49 YEARS	50-64 YEARS	65+ YEARS
Comprehensive Health Assessment	Initial complete history and physical within 12 months of enrollment with plan and at discretion of practitioner and patient Blood Pressure - At least every 1-2 years Height – Baseline and periodic as indicated Weight – Every 6 months, based on necessity
Cholesterol Screening	Men: 35-65 yrs   Women: 45-65 yrs If family history cannot be ascertained and other risk factors are present, blood test should be performed at the discretion of the practitioner.
Colon Cancer Screening			Annual fecal occult blood testing or Flexible sigmoidoscopy every 5 years or Fecal occult blood testing annually and flexible sigmoidoscopy every five years or Colonoscopy every 10 years or Barium enema every 5 years
Counseling / Education / Screening for High-Risk Factors	One or more of age appropriate counseling should be discussed during periodic primary care physician visits. Additional screening and intervention may be necessary for individuals at high-risk. Substance use (including tobacco, alcohol and drug use avoidance), diet and exercise, injury prevention, dental health and sexual behavior, use of complementary and alternative medicines.
HIV	Offer HIV testing to all women seeking preconception care and high-risk individuals: including infants born to high-risk mothers whose HIV status is unknown, past or present injection drug use, seeking treatment for STDs or whose partner is HIV positive, persons with multiple sex partners.
Hepatitis C	The hepatitis C virus test is recommended as a routine lab test for high-risk groups, including those with a history of injecting illegal drugs or who received blood transfusions or organ trasplant before July 1992, and children born to HCV positive women.
Depression	Screening for the following symptoms of depression should be done during periodic primary care pysician visits. Depressed mood Loss of interest or pleasure in nearly all activities Weight loss/gain Insomnia/hypersomnia Fatigue/loss of energy Worthlessness/guilt Impaired concentration Thoughts of death/suicidal ideation Psychomotor retardation/agitation Five (or more) of the symptoms present during the same 2-week period, a change from previous functioning and at least one of the symptoms is either depressed mood or loss of interest/pleasure may represent an episode of depression
Tuberculosis Screening	Review social and medical history and results of physical examination. Screen if risk identified; e.g., HIV positive, close contacts of persons with known or suspected TB, health care workers, persons with medical risk factors associated with TB, immigrants from countries with high TB prevalence, medically underserved low-income populations (including homeless), alcoholics, injection drug users and residents of long-term facilities. Test by Mantoux for high-risk individuals.
Diabetes Mellitus		45 & over: Screen at stated age; repeat as clinically indicated; If results are normal, repeat every three years. Consider testing in younger patients or perform more frequent testing in persons who meet the following criteria: Obesity (> 20% of desirable body weight or body mass index >27 kg/m^2) 1st degree relative with diabetes High-risk ethnic group (African American, Hispanic American, Native American, Asian American, Pacific Islander) Delivery of a baby weighing > 9 pounds or gestational DM Hypertension (>= 140/90 mm HG in adults) Plasma high-density lipoprotein cholesterol level < or = 35 mg/dL or triglyceride level > or = 250 mg/dL History of impaired glucose tolerance or impaired tasting glucose level (110-125 mg/dL)
For Men Only
Prostate Assessment		At age 40, African American males or positive family history: Annual digital rectal exams PSA at discretion of practitioner and patient	Annual digital rectal exams PSA at age 50+, with life expectancy greater than 10 years
Testicular Cancer Screening	21-39 yrs. Testicular exam and self-exam instructions as part of the periodic health exam.
For Women Only
Cervical Cancer Screening	Yearly; if three consecutive exams are normal, Pap test may be performed less frequently at discretion of the physician.
Breast Cancer Screening		> or = 40: Clinical breast exam (CBE) every 1-2 yr.
	35-49 yrs; Screening mammograms are appropriate at discretion of practitioner and patient.		50-69 yrs; Screening mammograms every 1-2 years.
Counseling Regarding Menopause	Women who are peri-menopausal should be counseled regarding menopause, treatment and lifestyle modifications which may be available.

Sources:

United States Preventive Service Task Force (USPSTF), American Diabetes Association (ADA), American Cancer Society (ACS), American College of Obstetricians and Gynecologists (ACOG), American Academy of Family Practitioners (AAFP), American College of Radiology (ACR), American College of Physicians (ACP).

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