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COVENTRY HEALTH CARE
CLINICAL PREVENTIVE SERVICES
2013
Coventry Health Care utilizes the U.S. Preventive Services Task Force (USPSTF) evidence-based recommendations
that have in effect a rating of “A” or “B”, in addition to other recognized guidelines/recommendations, for clinical
preventive services. The guidelines serve as recommendations for individuals at “normal risk”. Coventry’s
Preventive Health Guidelines will also include individuals with “risk factors” that impact a large number of
members and/or have potential for significant adverse health outcomes. Clinicians and patients should work
together to make decisions about which preventive services are most appropriate for individual patients. Some
individuals in certain higher risk categories may require earlier or more frequent screening exams and this should be
discussed with their physicians.
Coventry Health Care, Inc. preventive health guidelines do not reflect reimbursement or payment practices.
CLINICAL PREVENTIVE SERVICES (65 AND OLDER)
PREVENTIVE
SERVICES
RECOMMENDATION
REFERENCE
Abdominal Aortic
Aneurysm (AAA)
One-time screening for abdominal aortic aneurysm (AAA)
by ultrasonography in men aged 65 to 75 years who have
ever smoked.
Aspirin for men aged 45 to 79 years is recommended when
the potential benefit due to a reduction in myocardial
infarctions outweighs the potential harm due to an increase
in gastrointestinal hemorrhage. Aspirin is recommended for
women age 55 to 79 years when the potential benefit of a
reduction in ischemic strokes outweighs the potential harm
of an increase in gastrointestinal hemorrhage.
Screen 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.
Screening and behavioral counseling interventions to reduce
alcohol misuse by adults, including pregnant women.
Ask all adults about tobacco use and provide tobacco
cessation interventions for those who use tobacco products.
USPSTF: 2005
Recommends clinicians discuss chemoprevention with
women at high risk for breast cancer and at low risk for
adverse effects of chemoprevention. Clinicians should
inform patients of the potential benefits and harms of
chemoprevention.
Women whose family history is associated with an increased
risk for deleterious mutations in BRCA1 or BRCA2 genes be
referred for genetic counseling and evaluation for BRCA
testing.
USPSTF: 2002
Aspirin for the
Prevention of
Cardiovascular
Disease
Assess for Obesity
Assess for Problem
Drinking
Assess for Tobacco
Use and TobaccoCaused Disease
Breast Cancer
Preventive Medication
Breast (Ovarian)
Cancer Screening
USPSTF: 2009
USPSTF: 2012
HRSA:2008
USPSTF: 2004
USPSTF: 2009
USPSTF: 2005
US .Preventive Services Task Force (USPSTF), Guide to Clinical Preventive Services, Updates: 2003, 2004,
2005, 2007, 2008, 2009, 2010, 201, 2012, and 2013
American Dental Association (ADA) Policy
American Medical Association (AMA) Policy
United States Department of Agriculture (USDA), 2010
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2010
Institute for Clinical Systems Improvement Preventive Health guidelines 201, 2012
Centers for Medicare & Medicaid Services 2011
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COVENTRY HEALTH CARE
CLINICAL PREVENTIVE SERVICES
2013
CLINICAL PREVENTIVE SERVICES (65 AND OLDER)
PREVENTIVE
SERVICES
RECOMMENDATION
REFERENCE
Blood Pressure
Routine screening for all persons >18 years of age.
USPSTF: 2007
Cervical Cancer/
dysplasia screening
(Papanicolaou (Pap)
Test (Women)
Recommends screening for cervical cancer/dysplasia 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.
For community dwelling adults aged 65 years or older or
who are at increased risk for falls, recommend exercise or
physical therapy and vitamin D supplementations to prevent
falls.
Screen for colorectal cancer using annual fecal occult blood
testing, sigmoidoscopy every 5 years, or colonoscopy every
10 years, in adults, beginning at age 50 years and continuing
until age 75 years.
Screen for HCV infection to adults born between 1945
and 1965.
USPSTF: 2012
Human papillomavirus
testing
HPV Screening/Testing to begin at age 30 and occur
no more frequently than every 3 years. (See
Papanicolaou (PAP) test.)
HRSA: 2012
USPSTF: 2012
Lipid Disorder
Screening
Men: strongly recommends screening men aged 35 and
older for lipid disorders.
USPSTF:2008
Fall prevention in
Community-Dwelling
older Adults
Fecal Occult Blood
Test and/or
Sigmoidoscopy/
Colonoscopy
Hepatitis C (HCV)
screening
USPSTF: 2013
USPSTF:2008
USPSTF:2013
Women: strongly recommends screening women aged 45
and older for lipid disorders if they are at increased risk for
coronary heart disease.
Mammogram +
Clinical Breast Exam
(Women > 40 years)
Osteoporosis
Screening
Screening for
Depression
Screen for breast cancer every 1-2 years, with
mammography alone or mammography and annual clinical
breast examination for women > 40 years. Clinicians should
discuss the potential benefits versus potential harms and the
limitations of screening based on age.
Screen women 65 and older and younger women whose
fracture risk is equal or greater than that of a 65 year-old
white female who has no additional risk factors
Screen adults for depression when staff-assisted depression
care supports are in place to assure accurate diagnosis,
USPSTF:2002
USPSTF: 2011
USPSTF: 2009
US .Preventive Services Task Force (USPSTF), Guide to Clinical Preventive Services, Updates: 2003, 2004,
2005, 2007, 2008, 2009, 2010, 201, 2012, and 2013
American Dental Association (ADA) Policy
American Medical Association (AMA) Policy
United States Department of Agriculture (USDA), 2010
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2010
Institute for Clinical Systems Improvement Preventive Health guidelines 201, 2012
Centers for Medicare & Medicaid Services 2011
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COVENTRY HEALTH CARE
CLINICAL PREVENTIVE SERVICES
2013
CLINICAL PREVENTIVE SERVICES (65 AND OLDER)
PREVENTIVE
SERVICES
Tuberculin Test
Type 2 Diabetes
Mellitus Screen
Vision Screening
Well Woman Visit
Counseling
RECOMMENDATION
effective treatment, and follow-up
Risk Assessment to be performed and action to follow if
positive at age 1,6,12, 18 and 24 months then yearly
REFERENCE
HRSA/AAP: 2008
Screen for type 2 diabetes in asymptomatic adults with
sustained BP (either treated or untreated) greater than 135/80
mm Hg
Routine vision screening among the elderly, with Snellen
acuity testing.
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.
Injury Prevention
Lap-shoulder belts
USPSTF: 2008
Bicycle and motorcycle helmets
AMA: 2004
Smoke Alarms installed and maintained
AAP:2009
Safe storage/removal of firearms
AAP:2009
Fall prevention
ICSI:2012
Diet and Exercise
Limit trans and saturated fat and cholesterol; maintain
caloric balance; emphasize grains, fruits, vegetables
Regular physical activity
Substance Abuse
Avoid tobacco use
Avoid drinking and driving, do not ride with others under the
influence, and prevent others from driving under the
influence.
Menopause
Strategies for preventing chronic diseases in postmenopausal women. This approach should consider
individual risk factors and preferences in selecting effective
ICSI:2011
ACOG: 2012
HRSA:2012
AAP:2011
USDA: 2010
USPSTF:2009
ICSI:2012
ICSI:2011
US .Preventive Services Task Force (USPSTF), Guide to Clinical Preventive Services, Updates: 2003, 2004,
2005, 2007, 2008, 2009, 2010, 201, 2012, and 2013
American Dental Association (ADA) Policy
American Medical Association (AMA) Policy
United States Department of Agriculture (USDA), 2010
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2010
Institute for Clinical Systems Improvement Preventive Health guidelines 201, 2012
Centers for Medicare & Medicaid Services 2011
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COVENTRY HEALTH CARE
CLINICAL PREVENTIVE SERVICES
2013
CLINICAL PREVENTIVE SERVICES (65 AND OLDER)
PREVENTIVE
SERVICES
RECOMMENDATION
REFERENCE
interventions for reducing symptoms and gaining relief while
providing an opportunity to discuss the importance of
preventing menopause-related disease processes
Domestic Violence
Screening and counseling for interpersonal and domestic
violence for all women.
Dental Health
Regular visits to dental care provider
Floss and brush with fluoride toothpaste twice daily
Adequate calcium intake
USPSTF: 2013
HRSA 2012
HRSA:2008
ADA: 2013
US .Preventive Services Task Force (USPSTF), Guide to Clinical Preventive Services, Updates: 2003, 2004,
2005, 2007, 2008, 2009, 2010, 201, 2012, and 2013
American Dental Association (ADA) Policy
American Medical Association (AMA) Policy
United States Department of Agriculture (USDA), 2010
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2010
Institute for Clinical Systems Improvement Preventive Health guidelines 201, 2012
Centers for Medicare & Medicaid Services 2011
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