Chapter 6: Health Maintenance & Screening

Health Maintenance & Screening details the rigorous evidence-based methodologies used by organizations like the U.S. Preventive Services Task Force (USPSTF) to grade recommendations (A, B, C, D, and I) and the GRADE process for assessing the quality of evidence. A clear distinction is made between primary prevention, such as immunizations and behavioral counseling to prevent disease onset, and secondary prevention, which involves screening tests to detect asymptomatic disease at early stages. The text explores the complexities of screening, including necessary criteria like test accuracy and cost-effectiveness, while warning against potential pitfalls such as selection bias, lead-time bias, and length-time bias. A significant portion of the chapter focuses on behavioral counseling, outlining the Prochaska and DiClemente Transtheoretical Model of Change (precontemplation, contemplation, preparation, action, maintenance, and relapse) and the guiding style of motivational interviewing to facilitate lifestyle modifications. Specific clinical guidelines are provided for adult screenings, covering unhealthy weight and diabetes mellitus (using BMI and blood glucose metrics), substance use disorders (illicit drugs and prescription misuse), and intimate partner violence (IPV) or elder abuse. The chapter also details protocols for screening and counseling regarding unhealthy alcohol use (utilizing tools like SASQ, AUDIT-C, and the SBIRT model), tobacco cessation (employing the 5 As model and pharmacotherapy), and sexually transmitted infections, including HIV, Chlamydia, Gonorrhea, and Syphilis, emphasizing the importance of taking a nonjudgmental sexual history. Finally, the chapter provides an extensive overview of adult immunizations, explaining concepts like herd immunity and offering specific recommendations for the influenza, pneumococcal (PCV13 and PPSV23), varicella, herpes zoster, Tdap, HPV, and hepatitis A and B vaccines.