Download Primary Preventive Medicine Counseling and Discretionary

PERMANENTE PREVENTION COMMITTEE
Guideline Resource Document
GUIDELINE: Primary Preventive Medicine Counseling and
Discretionary Preventive Services
PREVIOUS RECOMMENDATION:
 Primary Preventive Medicine Counseling included recommendations on diet that were overly
detailed (including caloric balance, iron, folate), recommendations for post menopausal HRT, and
recommendations for calcium and diet that were too detailed.
 Discretionary Preventive Services included recommendations for dipstick urinalysis over age 60
and thyroid function testing.
NEW RECOMMENDATION:
1) Diet - changed to 'healthy diet' rich in vegetables and fruits or with recommended
amounts of vegetables and fruits
2) Eliminated post menopausal hormone replacement therapy recommendation
3) Removed bullets on calcium and vitamin d – since these continue to be controversial; instead,
replaced with 'Bone health - adequate calcium, vitamin D and weight bearing exercise'
4) Added other USPSTF a/b counseling recommendations, including alcohol misuse
counseling, breastfeeding counseling, obesity screening/counseling, skin cancer
prevention counseling (used instead of current 'avoid excessive sun exposure'),
tobacco counseling
5) Changed 'safer sexual practices' to 'safe sexual practices'
6) Eliminated section on Discretionary Preventive Services
NEW RECOMMENDATION BASED ON:
 Alignment with language on other PPC documents - e.g. diet recommendations aligned with
language on Obesity HO, bone health language aligned with Osteoporosis HO
 USPSTF most current A/B recommendations - link:
http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm
DISCUSSION WITH SUBJECT MATTER EXPERTS:
 Alignment with other guidelines and PPC documents is important.
 Because of controversy regarding recommendations for calcium and vitamin D - instead of being
specific, emphasized bone health, adequate calcium, vitamin D, and weight bearing exercises
 HRT is no longer recommended in practice given results of WHI study. Also listed as a D
recommendation under USPSTF.
 Added other USPSTF a/b counseling recommendations for consistency and completeness.
 Recommendations under Discretionary Preventive Services are not needed.
PPC SUMMARY:
Recommendations revised based on most current USPSTF A/B recommendations on counseling.
PPC reviewed and approved: 06/27/13 with no changes 09/03/15
S. Nathaniel – Prevention & HE
06/27/13