Preventive Health Care Guideline

Preventive Health Care Guideline

Unity and our health care practitioners are dedicated to help you and your family achieve good health and wellness. Prevention and early detection of illness and disease through check-ups, screenings, health education, and lifestyle choices are the ways to keep you and your family healthy. This Preventive Health Care Guideline is the suggested courses of action we recommend for you. This guideline addresses topics such as check-up/physical exams, screenings for disease and health conditions, vaccinations, lifestyle choices (e.g., nutrition, exercise, alcohol/tobacco/drug use), mental and behavioral health, and safety. The Preventive Health Care Guideline sections are: PRE-PREGNANCY PRENATAL POSTPARTUM NEWBORN CHILD ADULT Please discuss any questions or concerns about these recommendations with your practitioner. Be sure to talk about all of your health conditions, diseases, family history, concerns and lifestyle choices. Your practitioner may make changes to this guideline based on your personal health status or situation.

PRE-PREGNANCY HEALTH CARE Planning for your pregnancy helps you make choices that are good for you and your baby. Being healthy and prepared helps your body better handle the stress of pregnancy, labor, and delivery. MULTIVITAMINS WITH FOLIC ACID A deficiency in folic acid can lead to neural tube (spinal cord) birth defects such as spinal bifida, cleft lip, and cleft palate. It is recommended to take a multivitamin with 0.4-0.8mg of folic acid everyday for at least one month before becoming pregnant and throughout your pregnancy. TOBACCO USE Using tobacco can lead to a lower birth weight, which is often associated with health issues for the baby. It may not be easy to quit using tobacco, but keep trying for the health of you and your baby. Talk with your practitioner about getting help to stop tobacco use. ALCOHOL USE Drinking alcohol during pregnancy can cause lower birth weight, heart or brain defects, or fetal alcohol syndrome. It is best not to drink alcohol while pregnant. Talk with your practitioner about getting help to stop drinking alcohol before you become pregnant. SCREENING FOR RUBELLA (GERMAN MEASLES) German measles during pregnancy can cause birth defects. The rubella vaccine is recommended for women of childbearing age who have no previous history of vaccination or immunity. Have a rubella vaccination at least four weeks prior to becoming pregnant. SCREENING FOR VARICELLA (CHICKEN POX) Chicken pox during pregnancy can cause birth defects. The varicella vaccine is recommended for women of childbearing age who have no previous history of vaccination or immunity. Start your varicella vaccination series at least eight weeks prior to becoming pregnant. SCREENING FOR HIV/AIDS Screening for HIV/AIDS will occur before becoming pregnant. If you test positive, a treatment plan will be followed in order to greatly reduce the risk of passing HIV on to your child during or after birth.

PRENATAL HEALTH CARE At your first prenatal visit talk with your practitioner about the following health care guidelines that are recommended to happen during pregnancy. The pre-pregnancy suggestions on the previous page will continue to apply to your prenatal guidelines. FREQUENCY OF PRENATAL VISITS You will need to see your practitioner throughout your pregnancy using the following schedule: GESTATIONAL AGE FREQUENCY OF VISITS 4-32 weeks Every 4 weeks 32-36 weeks Every 2-3 weeks 37+ weeks Every week SCREENINGS FOR HEPATITIS B Hepatitis B is a long-term illness that can lead to liver damage, liver cancer, and sometimes death. It can be passed from mother to baby. Screening for hepatitis B should occur at the first prenatal visit. SCREENING FOR SYPHILIS Syphilis is a sexually transmitted infection (STI). It can be passed from mother to baby. Screening for syphilis should occur at the first prenatal visit. URINE TEST A urine test screens for high bacteria level. A test is recommended at 12-16 weeks of pregnancy. If bacteria is found and treated early, it may lower the rate of urinary infections and related problems. A urine culture is also recommended to screen for asymptomatic bacteria (bacteria in your urine that has no symptoms of a urinary tract infection) which can lead to low birth weight and pre-term delivery.

PRENATAL HEALTH CARE SCREENING FOR GROUP B STREPTOCOCCUS Group B streptococcus (strep) is a bacteria found in the vagina of pregnant women. You may not have any symptoms, but the bacteria can cause serious infections to your baby. A vaginal swab test, or treatment depending on your risks, is recommended at 35-37 weeks. SCREENING FOR GESTATIONAL DIABETES A diabetes test measures the amount of sugar in the blood. Screening for gestational diabetes is recommended at 26-30 weeks of pregnancy or sooner if at risk. INFLUENZA (FLU) VACCINATION The flu vaccine protects you against some types of the flu. It is recommended annually before or during the flu season for pregnant women. TETANUS, DIPHTHERIA, AND PERTUSSIS (TDaP) VACCINATION The TDaP vaccine protects you against the tetanus, diphtheria, and pertussis diseases. If you have not been vaccinated in the past ten years it is recommended at 27-36 weeks of pregnancy. COUNSELING Practitioners often discuss health and safety during prenatal visits. This is a time to learn what you can do to help your baby have a healthy start. Topics may include diet, nutrition, physical activity, alcohol and drug use, domestic violence, and safety.

POSTPARTUM HEALTH CARE Your care continues after you have given birth. Taking care of yourself will help both you and your baby to be as healthy as possible. CHECK-UP AFTER DELIVERY Return to your practitioner for a check-up within 4-6 weeks of delivery, or sooner if there were complications with delivery. During the visit, the practitioner will check your weight, blood pressure, breasts, abdomen, and perform a pelvic exam. VARICELLA (CHICKEN POX) VACCINATION Varicella vaccination is recommended after pregnancy if no previous history of immunization or immunity. RUBELLA (GERMAN MEASLES) VACCINATION Rubella vaccination is recommended after pregnancy if no previous history of immunization or immunity. POSTPARTUM DEPRESSION Some women feel sad after delivery. Most often the feelings are mild and go away within a few weeks. However, in some cases the feelings become overwhelming and do not go away. This can be a signal of a more severe condition called postpartum depression. If you feel you are suffering from postpartum depression, contact your primary care provider immediately.

NEONATAL (NEWBORN) HEALTH CARE OPHTHALMIC (EYE) ANTIBIOTIC Your baby needs to receive an eye treatment within one hour of birth. This treatment decreases the likelihood of a serious eye infection that can be transmitted during passage through the birth (vaginal) canal. VITAMIN K SHOT Your baby needs to receive a single shot of natural vitamin K within one hour of birth because a newborn s body cannot make vitamin K on its own for a few days. Vitamin K helps the blood clot, and protects against a rare but severe bleeding disease. NEONATAL SCREENING Neonatal screening is performed by testing a sample of blood. It detects rare diseases such as hemoglobinopathies phenylketonuria (PKU), and congenital hypothyroidism. HEARING SCREENING Early identification of hearing loss, no matter how slight, ensures a better chance for your baby s optimal development and successful treatment. VISION SCREENING Early detection and treatment of eye disorders is important to avoid lifelong visual impairment and permanent vision loss. BREASTFEEDING Breastfeeding has been proven to be healthier for babies than formula. It provides babies with benefits such as fewer infections and allergies, and decreased chance at developing childhood obesity. HEPATITIS B VACCINATION Hepatitis B is a disease that can lead to liver damage, liver cancer, and sometimes death. The hepatitis B vaccination decreases the likelihood of developing this disease. Your baby can receive the first dose of the hepatitis B vaccine within 12 hours of birth.

CHILD HEALTH CARE PHYSICAL EXAMS Physical exams are a time to discuss disease prevention and healthy living. Below is the recommended schedule for physical exams. RECOMMENDED PHYSICAL EXAM SCHEDULE Birth 1 month 3 visits: 1st at Birth; 2nd at 2-4 days; 3rd at 5 days - 1 month 2 Months Once 3 Months Once 4 Months Once 5 Months Once 12 Months Once 15 Months Once 18 Months Once 24 Months Once 30 Months Only for BadgerCare Plus members 3-6 Years Annually 7 10 Years 2 Visits: 1st at 8 years; 2nd at 10 years 11 17 Years Annually CHILDHOOD IMMUNIZATIONS Childhood vaccinations prevent many diseases that can affect children, adolescents, and adults. Children need to receive vaccinations according to the recommended schedule. Changes to the childhood immunization schedule happen periodically due to clinical guideline updates and immunization shortages. Discuss changes with your child s practitioner and check the Centers for Disease Control and Prevention at cdc.gov/vaccines or 1-800-CDC-INFO, or check the Immunization Action Coalition at vaccineinformation.org for the latest schedule.

CHILD HEALTH CARE BLOOD LEAD TEST A blood lead test is used to detect high levels of lead in children. The main source of high blood lead levels is exposure to lead paint dust and chips in older homes. High blood lead levels can have long-term effects on behavior and learning. Many children who are lead poisoned show no symptoms, so the only way to know is to have a blood lead test done. Parents need to answer the following questions when their child is 12 and 24-months of age: QUESTION: 1.Does the child live in or visit a building constructed before 1950? Has the child in the past? 2.Does the child live in or visit a building constructed before 1978 with recent or ongoing renovation? Has the child in the past? 3.Does the child have a brother, sister or playmate who has or has had lead poisoning? 4.Is the child eligible for Medicaid, HealthCheck or WIC? TEST IF ANSWER IS: Yes I don t know Yes I don t know Yes I don t know Yes I don t know If you answered Yes or Don t know to any of the questions, then your child needs a blood lead test at 12 and 24 months of age. Practitioners often discuss safety and healthy living during office visits. Some topics that are often discussed during these visits include: NUTRITION To achieve the best possible health it is important your child eat plenty of fruits, vegetables, foods high in calcium (such as dairy products and broccoli) and foods high in fiber (such as in whole grains). EXERCISE Exercise helps your child maintain a healthy and strong body. Encouraging your child to be active early in life will help promote an exercise pattern throughout his/her life.

CHILD HEALTH CARE AVOID INJURY Car Safety Use safety features such as car seats and seat belts for your children. Cars need airbags to ensure the safety of you and your family. Remember; don t put infants and children in a seat with an airbag, which usually means they should be in the back seat. Water Safety An adult needs to supervise children while in bathtubs and pools at all times. CPR training for pool owners, parents, and caretakers is highly recommended. Fire and Burns Set your water heater temperature to less than 120 F to avoid burns. Children should wear non-flammable sleepwear to reduce injury from fire. Make sure your smoke and carbon monoxide detectors are properly installed and make sure to test them monthly. Poisoning Poisoning is a common cause of injury and death. Keep medications in childproof safety containers out of reach. Have your local poison control number readily available. Talk with your practitioner about what to do in case of poisoning. Bicycle, ATV and Motorcycle It is recommended to wear approved bicycle, ATV, and motorcycle helmets to prevent serious injury or death. Children under the age of 16 are advised to not operate off-road motorized vehicles. Falls If you live in a high-rise building, window guards can reduce the risk of serious injury or death from falls. Firearm Safety If there are firearms in the home, keep them properly stored, locked up, and unloaded at all times to avoid injury. Sun Safety Be aware of the role the sun plays in causing skin cancer. Children need to avoid the sun or cover up as much as possible when outside, even on cloudy days. A sunscreen of SPF 15 or greater is recommended.

CHILD HEALTH CARE PREVENTING DENTAL DISEASE Beginning at ages 2-3, your child needs to begin seeing the dentist and start regular brushing and flossing. SEXUAL HEALTH Parents are advised to discuss sexual health with their child. It is recommended for parents and their child to talk with their practitioner about sexual maturation, sexual activity, birth control, and ways to protect against sexually transmitted infections (STI) and gynecological cancers. PAP TEST A Pap test is used to detect cancer and find pre-cancerous cells in the cervix so early treatment can begin. A Pap test is recommended every three years for all sexually active women beginning at 21 years of age. After three negative exams, the Pap test may be done every 2-3 years. SCREENING FOR CHLAMYDIA Chlamydia is a sexually transmitted infection (STI) that, if left untreated, can lead to severe reproductive and health problems. Most women experience no symptoms. When diagnosed early, Chlamydia can be easily treated and cured. Chlamydia screening is recommended annually for all sexually active females 25 years and younger. TOBACCO & SUBSTANCE USE Tobacco use, such as smoking, can cause cancer, heart disease, and lung disease. Secondhand smoke can also cause lung cancer for people who do not smoke, and respiratory illnesses such as asthma. Parents are advised to discuss the negative effects of tobacco use with their child. It is recommended for parents and their child to talk with their practitioner about not starting tobacco use, or techniques to quit. LIPID SCREENING High blood lipids (fat in the blood) are a known risk factor for heart disease. Blood lipid testing is recommended for children at risk, starting at the age of 2. If not at risk, a non-fasting cholesterol and HDL should be tested for children ages 9-10.

ADULT HEALTH CARE BLOOD PRESSURE Studies have shown that finding and treating high blood pressure early can reduce heart disease and stroke. It is recommended for adults to have their blood pressure checked every 1-2 years beginning at age 18. TOBACCO & SUBSTANCE USE Tobacco use can cause cancer, heart disease, and lung disease. Secondhand smoke can cause lung cancer for people who do not smoke, and respiratory illnesses such as asthma. It is not easy to quit using tobacco; many people try to quit several times before they permanent quit. Talk with your practitioner about getting help to stop tobacco use. ALCOHOL USE Heavy alcohol use can lead to serious and life-threatening consequences. It can increase the risk for certain cancers, and cause liver cirrhosis, and immune system problems. Talk with your practitioner if you think you may have a drinking problem. SCREENING FOR CHLAMYDIA Chlamydia is a sexually transmitted infection (STI) that, if left untreated, can lead to severe reproductive and health problems. Most women experience no symptoms. When diagnosed early, Chlamydia can be easily treated and cured. A Chlamydia screen is recommended annually for all sexually active females 24 years and younger. PAP TEST A Pap test is used to detect cancer and find pre-cancerous cells in the cervix so early treatment can begin. A Pap test is recommended every three years for all sexually active women beginning at 21 years of age. After three negative exams, the Pap test may be done every 2-3 years. SCREENING FOR BREAST CANCER A mammogram is a screening test to find breast cancer. Finding and treating breast cancer early reduces the risk of dying from the disease. It is recommended that women have a baseline mammogram at 40-49 years of age, and every 1-2 years until the age of 74.

ADULT HEALTH CARE SCREENING FOR COLORECTAL CANCER Early detection of colorectal (colon and rectal) cancer reduces the number of deaths from colorectal cancer. There are several screening options, so make sure to talk with your health care practitioner about which option is best for you. Screening is recommended for adults 50 years and older every 5 or 10 years, depending on the type of screening. SCREENING FOR PRE-DIABETES AND DIABETES People with diabetes are at increased risk for health complications such as blindness, kidney disease, cardiovascular disease, and stroke. The development of, and complications from, diabetes can be delayed or prevented by making lifestyle changes, taking medication, and having regular visits to your practitioner. Regular screening for diabetes is recommended for everyone every three years starting at age 45. Talk with your practitioner if you have risk factors for developing diabetes such as family history, physical inactivity, or hypertension as you may need more frequent screening. LIPID SCREENING High blood lipids (fat in the blood) are a known risk factor for heart disease. Blood lipid testing is recommended once between ages 17-21, then every 5 years. You can lower your blood lipids by eating fewer fatty foods, getting more exercise, and in some cases by taking medications. INFLUENZA (FLU) VACCINATION The flu vaccine protects you against some types of the flu. It is recommended annually before the flu season for all adults especially people with health conditions such as asthma and diabetes. PNEUMOCOCCAL VACCINATION The pneumococcal vaccine protects you against some kinds of pneumonia. It is recommended for adults 65 years and older. Those younger than 65 who have a health condition that gets worse with pneumonia, such as diabetes, need to receive the vaccination.

ADULT HEALTH CARE OTHER VACCINATIONS One or two doses of the measles, mumps, rubella (MMR) vaccination is recommended between the ages of 18 and 59. Talk to your practitioner if you were born after 1956 and don t have a record of having this vaccination. They can determine how many doses are needed. A hepatitis B vaccination is recommended if you have not had the vaccination and are in a high-risk group, such as injection drug users, person with multiple sex partners, persons with same sex partners, recipients of certain blood products, and some health care workers. A tetanus, diphtheria (Td) or tetanus, diphtheria, pertussis (Tdap) vaccination is recommended every 10 years for all adults ages 18 and older. A one time Tdap booster is recommended between 18 and 64 years of age. Changes to the adult immunization schedule happen periodically due to clinical guideline updates and immunization shortages. Discuss changes with your practitioner and check the Centers for Disease Control and Prevention at cdc.gov or 1-800-CDC-INFO, or check the Immunization Action Coalition at vaccineinformation.org for the latest schedule.

Please consider the following recommendations to help you maintain good health and prevent disease. Nutrition To achieve optimum health it is important to eat plenty of fruits, vegetables, foods high in calcium (such as dairy products and broccoli) and foods high in fiber (such as whole grains), and limit fat intake. Exercise Exercise helps you maintain a healthy and strong body. The benefits of being active are endless. Exercise helps maintain caloric balance and can reduce the risk of health conditions such as heart disease, diabetes, and stroke. Motor and Bicycle Safety It is recommended that passengers and drivers always use safety features such as seat belts. Cars have airbags to ensure the safety of you and your family. Avoid driving under the influence of alcohol, illicit drugs, or non-prescribed addictive drugs. It is recommended to use an approved helmet while on a bicycle or motorcycle to prevent serious injury or death. Sun Safety Be aware of the role the sun plays in causing skin cancer. Avoid the sun or cover up as much as possible when outside, even on cloudy days. A sunscreen of SPF 15 or greater is recommended. Dental Care Brush with a fluoride toothpaste and floss regularly. Visit your dental care practitioner two times each year to maintain a healthy mouth and teeth.

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