Footnotes

These recommendations are not to be confused with the benefits covered by PacifiCare/Secure Horizons as defined in the member’s Evidence of Coverage/Disclosure Form. Nothing in these guidelines should be construed to establish a new benefit under PacifiCare or indicate a change in federal or state required benefits. The PacifiCare/Secure Horizons member’s Evidence of Coverage/Disclosure Form should be consulted for the specific coverage and limitations of benefits.
References: American Academy of Pediatrics (AAP), Centers for Disease Control and Prevention (CDC) and US Preventive Services Task Force (USPSTF). Unless otherwise specified, please note that the (A) and (B) designations for each recommendation reflect the evidence rating assigned by the USPSTF.

1. The AAP recommends a clinical assessment of blood pressure during office visits from age 3. The USPSTF recommends blood pressure screening during office visits for children and adolescents (B).
2. The USPSTF recommends periodic screening for hypertension for all persons age 21 and older (A).
3. The USPSTF recommends screening mammography, with or without clinical breast examination, every 1 to 2 years for women age 40 and older (B). The USPSTF further recommends women be informed of potential benefits, limitations, and possible harms of mammography in making decisions about when to begin screening.
4. The USPSTF recommends cervical cancer screening (Pap test) for all women who are or have been sexually active and who have a cervix (A). Testing should begin at the age when the woman first engages in sexual intercourse or age 18. There is little evidence that annual screening achieves better outcomes than screening every 3 years. Pap tests should be performed at least every 3 years (B) with the interval recommended by the physician based on risk factors. There is insufficient evidence to recommend for or against an upper age limit but recommendations can be made on other grounds for discontinuation of regular testing after age 65 in women who have had regular previous screening in which the smears have been consistently normal (C).
5. The USPSTF strongly recommends routinely screening all sexually active women age 25 and younger and other asymptomatic women at increased risk for infection, for chlamydial infection (A).
6. The USPSTF recommends FOBT annually beginning at age 50 or sigmoidoscopy (periodicity unspecified) or both (B). The American Cancer Society and American College of Gastroenterology recommend additional, alternative screening procedures at specified intervals.
7. The USPSTF recommends training primary care physicians in recognizing and treating affective disorders in order to prevent suicide (B). According to the Agency for Healthcare Research and Quality (formerly AHCPR) guideline, the clinical interview is the most effective method for detecting depression. The interview elicits the nine criterion symptoms of major depressive disorder and the longitudinal course of illness. Similarly, interviewing for symptoms and course of illness is essential to identifying bipolar, dysthymic, and other mood disorders. Specific questions regarding the criterion symptoms are asked. Since either a depressed, blue, or sad mood or a loss of interest or pleasure is required, these symptoms are elicited first. The clinician who suspects or diagnoses a depressive disorder is advised to perform and record the results of mental status examination, which include whether the patient has suicidal ideation/intention; is oriented, alert, cooperative, and communicative; exhibits a normal level of motor activity; and is psychotic (A).
8. The American Diabetes Association recommends, on the basis of Expert Opinion, that evaluation of high-risk individuals be considered at 3-year intervals beginning at age 45; testing should be considered at an earlier age or be carried out more frequently if one or more diabetes risk factors are present (Expert Opinion). Diabetes risk factors include a family history of diabetes, obesity defined as BMI>27kg/m2, habitual physical inactivity, belonging to a high-risk ethnic or racial group, previously identified impaired fasting glucose or impaired glucose tolerance, hypertension, dyslipidemia, history of gestational diabetes or delivery of a baby weighting >9lbs, and polycystic ovary syndrome (B). However, based on lack of data from prospective studies on the benefits of screening and the relatively low cost-effectiveness of screening suggested by existing studies, the decision to test for diabetes should ultimately be based on clinical judgement. Fasting Plasma Glucose is preferred for screening because it is faster and easier to perform, more convenient, acceptable to patients and less expensive. Oral Glucose Tolerance Test may be necessary for the diagnosis of diabetes when the fasting plasma glucose is normal (C).
9. The USPSTF concluded there is insufficient evidence to recommend for or against routine screening of newborns for hearing loss during the postpartum hospitalization (I). The USPSTF recommends screening older adults for hearing impairment by periodically questioning them about their hearing, counseling them about the availability of hearing aid devices and making referrals for abnormalities when appropriate. The optimal frequency of such screening has not been determined and is left for clinical discretion. (B).
10. The APA and USPSTF recommend periodic height and weight measurements plotted on growth chart (B).
11. The USPSTF recommends screening for elevated lead levels by measuring blood lead at least once age 12 months for all children at increased risk for lead exposure (B).
12. The USPSTF strongly recommends routinely screening men age 35 and older and women age 45 and older for lipid disorders and treating abnormal lipids in people who are at increased risk of coronary heart disease (A). The USPSTF recommends routinely screening younger adults for lipid disorders if they have other risk factors for coronary heart disease (B).
13. The USPSTF does not recommend routine screening for prostate cancer. Patients who request screening should be given objective information about the potential benefits and harms of early detection and treatment.
14. The USPSTF recommends screening by tuberculin skin testing for all persons at increased risk of developing tuberculosis (A).
15. The USPSTF recommends vision screening for amblyopia and strabismus once before entering school (preferably between age 3–4 years) (B). There is insufficient evidence to recommend for or against routine screening by primary care practitioners for elevated intraocular pressure or early glaucoma (C). Recommendations to refer high-risk patients for evaluation by eye specialist may be based on the substantial prevalence of unrecognized glaucoma in these populations, the progressive nature of untreated disease, and expert consensus that reducing intraocular pressure may slow the rate of visual loss in patients with early glaucoma or severe intraocular hypertension. Populations in whom the prevalence is >1% include blacks over age 40 and whites over age 65. Patients with family history of glaucoma, patients with diabetes, and patients with severe myopia are also at increased risk. The optimal frequency for glaucoma screening has not been determined and is left to clinical discretion
16. Counseling patients to visit a dental care provider on a regular basis is recommended by the USPSTF based on evidence for risk reduction from such visits when combined with personal oral hygiene (B). The AAP recommends regular dental care beginning at 3 years. Clinicians caring for children should ascertain the fluoride concentration of their water supply. For children living in an area with inadequate water fluoridation (<0.06 ppm), the prescription of daily fluoride drops or tablets is recommended (A)
17. The USPSTF recommends counseling to promote regular physical activity for all children and adults to prevent coronary heart disease, hypertension, obesity, and diabetes (A). Adults and children over age 2 should limit dietary intake of fat (A) and cholesterol (B), maintain caloric balance in their diet (B), and emphasize fruits, vegetables, and grain products containing fiber (B). Parents should be encourage to offer breastfeeding to their infants (A) and to include iron-enriched foods in their diet (B)
18. The USPSTF recommends clinicians counsel all women around the time of menopause about the possible benefits and risks of post-menopausal hormone therapy and the available treatment options (B).
19. Injury prevention is addressed under USPSTF recommendation for periodic counseling. (B)
20. The CDC Task Force on Community Preventive Services strongly recommends interventions to increase use of child safety seats, increase safety belt use and reduce alcohol-impaired driving
21. The American College of Obstetricians and Gynecologists (ACOG) recommends prenatal care beginning early in pregnancy and continuing through the postpartum period.
22. The USPSTF recommends that to reduce the risk of neural tube defects in newborns, all women not planning but still capable of pregnancy should take a multivitamin containing 0.4mg of folic acid daily (B)
23. The USPSTF recommends that all adolescent and adult patients be advised about risk factors for sexually transmitted disease and counseled appropriately about effective measures to reduce risk of infection (B). Periodic counseling about effective contraceptive methods is recommended for all women and men at risk for unintended pregnancy (B)
24. The USPSTF recommends pregnant women and parents with children living at home also should be counseled on the potentially harmful effects of smoking on fetal and child health (A). Screening to detect problem drinking and hazardous drinking is recommended for all adults and adolescents (B). All adolescents and adults who use alcohol or other drugs should be advised to avoid engaging in potentially dangerous activities while intoxicated (B). The US Public Health Service recommends all patients should be asked if they use tobacco and should have their tobacco-use status documented on a regular basis. Evidence has shown that this significantly increases rates of clinician intervention (A). All physicians strongly advise every patient who smokes to quit because evidence shows that physician advise to quit smoking increases abstinence rates (A). All clinicians should strongly advise patients who use tobacco to quit (B).
25. The ACIP Schedule (Jan–Dec 2002), updated annually by the CDC’s Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), and the AAP, is recommended. The schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines. Combination vaccines may be used whenever the combination is licensed for use any components of the combination are indicated and its other components are not contraindicated. Providers should consult the manufacturers’ package inserts for detailed recommendations.
26. DTaP is the preferred vaccine for all doses, including completion of a series begun with whole cell DTP according to ACIP guidelines. The fourth dose may be administered as early as 12 months, provided 6 months have elapsed since the 3rd dose and if the child is unlikely to return at age 15–18 months. The ACIP recommends that, whenever feasible, the same brand of DTaP vaccine be used for all doses in the vaccine series. When unknown or not available, any of the licensed vaccines can be used.
27. The ACIP recommends Td vaccination at 11–12 years of age if at least 5 years have elapsed since the last dose of DTP, DtaP or DT. Subsequent Td boosters are recommended every 10 years thereafter. Tetanus prophylaxis in routine wound management if other than clean or minor wound and >5 years since last dose.
28. The ACIP recommends only FDA-approved combination products for primary Haemophilus influenza type B (HiB) vaccination in infants 2, 4 or 6 months.
29. The ACIP recommends Hepatitis A vaccination for persons, >2 years, who are at increased risk for infection (travelers, men who have sex with men, illegal-drug users, occupational risk, clotting-factor disorder, chronic liver disease – consult ACIP) and any person wishing to obtain immunity. Children, > 2 years, living in areas where rates of hepatitis A are at least twice (>20 cases per 100,000 population) the national average, should be routinely vaccinated. Vaccination should be considered for children living in areas where rates of hepatitis A are at (>10 <20 cases per 100,000 population) the national average. The schedule is determined based on vaccine formulation and age. Contact local public health authority for current recommendations.
30. Infants born to hepatitis B surface antigen (HbsAg)-negative mothers should receive the 1st does of hepatitis B vaccine by age 2 months. The 2nd dose should be at least 1 month after the 1st dose. The 3rd dose should be administered at least 4 months after the 1st does and at least 2 months after the 2nd does, but not before 6 months of age. Infants born to HBS-Ag-positive mothers should receive hepatitis B vaccine and 0.5 ml hepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites. The 2nd dose is recommended at 1 month of age and the 3rd dose at 6 months of age. Infants born to mothers whose HbsAG status is unknown should receive hepatitis B vaccine within 12 hours of birth. Maternal blood should be drawn at the time of delivery to determine the mother’s Hasbro status; if the Hasbro test is positive, the infant should receive HBIG as soon as possible (no later than 1 week of age).
31. The USPSTF recommends administering Hepatitis B immunization for all young adults not been previously immunized. The immunizations should be given at the current visit and during visits 1 and 6 months thereafter (A). CDC, AAP and AAFP guidelines state children who have not previously received 3 doses of hepatitis B vaccine should initiate or complete the series during the 11 – 12 year old visit. The 2nd dose should be administered at least 1 month after the 1st dose and the 3rd dose should be at least 4 months after the 1st and at least 2 months after the 2nd dose.
32. The ACIP recommends influenza vaccination for any person >6 months, who because of age or underlying medical condition, is at increased risk for complications of influenza. Groups at increased risk include: residents of nursing home or other chronic care facilities; adults or children who have chronic disorders of pulmonary or cardiovascular systems or who have required regular medical follow-up or hospitalization because of chronic metabolic disease (including diabetes), renal dysfunction, hemoglobinopathies, or immunosuppression; children or adolescents receiving long-term aspirin therapy; and women who will be in the 2nd or 3rd trimester of pregnancy during the influenza season. Care givers to persons at high risk, persons in institutional settings, providing essential community services and other persons who wish to reduce the likelihood of becoming ill with influenza, should be considered for vaccination
33. The ACIP recommends the 2nd MMR vaccination at 4–6 years of age but vaccine may be administered during any visit provided at least 4 weeks have elapsed since receipt of the 1st dose and that both does are administered beginning at or after 12 months of age. Those who have not previously received the 2nd dose should complete the schedule by the 11–12 years old visit.
34. The ACIP recommends that providers of medical care to incoming and current college freshmen, particularly those who plan to or already live in dormitories and residence halls, should, during routine medical care, inform these students and their parents about meningococcal disease and the benefits of vaccination. ACIP does not recommend that the level of increased risk among freshman warrants any specific changes in living situations for freshman. College freshman who want to reduce their risk for meningococcal disease should be administered vaccine.
35. The ACIP recommends an all-inactivated poliovirus (IPV) vaccination at 2, 4, 6–18 months and at 4–6 years. For children who have already received oral polio vaccine (OPV) but have not completed the series, the additional doses should be IPV. If accelerated protection is needed, the minimum interval between doses is 4 weeks, although the preferred interval between the 2nd and 3rd doses is 2 months. All children who received three doses of IPV before age 4 years should receive a 4th dose before or at school entry. The 4th dose is not needed if the 3rd dose is administered on or after the 4th birthday.
36. The ACIP recommends pneumococcal vaccine for all immunocompetent persons who are 65 years and older with 2nd dose if vaccine was administered under age 65 years and more than 5 years previously (A). Additionally vaccination is recommended, for persons age 2–64 years with chronic cardiovascular disease, chronic pulmonary disease, diabetes, or functional/anatomic asplenia (A). For persons > 10 years with asplenia, single revaccination > 5 years after previous dose. For persons < 10 years with asplenia, consider revaccination 3 years after previous dose (A).
37. The USPSTF recommends screening for rubella susceptibility by history of vaccination or by serology for all women of childbearing age (B). Alternatively, all susceptible nonpregnant women of childbearing age should be offered vaccination against rubella without screening (B).
38. The ACIP recommends vaccination at any visit on or after the first birthday for susceptible children, i.e. those who lack a reliable history of chickenpox (as judged by a health care provider) and have who have not been immunized. Susceptible persons age >13 years at high risk for exposure or transmission should receive 2 doses, given at least 4 weeks apart.
39. The ACIP recommends all children age <23 months should be vaccinated with PCV7. Infant vaccination provides the earliest possible protection, age 2–6 months and age 7–23 months (B). Children age 24–59 months should receive PCV7 vaccination if they are at high risk for pneumococcal infection caused by an underlying medical condition. This recommendation applies to the following groups: children with sickle cell disease and other sickle cell hemoglobinopathies, including hemoglobin SS, hemoglobin S-C, or hemoglobin s-á-thalassemia, or children who are functionally or anatomically asplenic (B); children with HIV infection (B); children who have chronic disease, including chronic cardiac and pulmonary disease (excluding asthma), diabetes mellitus, or CSF leak; and children with immunocompromising conditions including a) malignancies, b) chronic renal failure or nephrotic syndrome; c) those children receiving immunosuppressive chemotherapy, including long-term systemic corticosteroids; and d) those children who have received a solid organ transplant (C). The ACIP further recommends that PCV7 vaccination (1 dose) be considered for all other unvaccinated children age 24–59 months with priority given to children age 24–35 months, children of Alaska Native, American Indian or African-American descent, and children who attend group day care centers (B). Modified recommendations apply during periods of shortage. See MMWR 12/21/02.