Discuss a primary care-focused visit devoted to wellness and or disease affecting women and health-enhancing strategies that you would include in the visit.
Peer 1 Response
One primary care-focused visit devoted to wellness is the annual wellness visit (AWV). Components of this visit should include updating immunizations and suggesting needed immunizations, blood pressure checks to screen for hypertension, obesity counseling if needed, and any counseling for tobacco and alcohol use. Also important is doing a functional status review, screening for fall risk and cognitive abilities for seniors (Adler, 2017). If the patient were a senior with a chronic problem it would be good to do problem-focused physical exam and explore any patient concerns, if any. The Medicare Annual Wellness Visit is still an underutilized benefit for seniors, even though it can offer many benefits to increase a person’s preventive care. According to (Harvard Men’s Health Watch, 2017), this visit does not focus on a physical exam, but is instead a conversation with your health care provider about important health issues. This visit provides time for the patient to plan with their health care provider a healthy future. Other health-enhancing strategies focused on in this visit are a vision test, to detect if the patient needs glasses, a stronger prescription, or have signs of an eye disease. A balance test will be done to help gauge the risk for falls, as well as a hearing evaluation to see if the patient would benefit from a formal hearing test.
Another part of the AWV is developing a personalized plan to address ways the patient can stay active and maintain their current health. One primary care assessment that should be done at every visit is a depression screening. This doesn’t have to be a long questionnaire, the Patient Health Questionnaire (PHQ-2) is a good screening tool. It consists of just 2 questions from the PHQ-9. If the patient screens positive with the PHQ-2, the full PHQ-9 can be completed. According (Fuchs, Haradhvala, & Uebelacker, 2015), the PHQ-2 has demonstrated strong validity and high sensitivity for detecting major depression in primary care.
Peer 2 Response
Women’s health care is a detailed visit that is focused on many different aspects of care. For example, women need education on special topics at all ages of life. One of the major concerns for aging women is osteoporosis. Osteoporosis is a disease of the bones that occurs when there is bone loss, or the body makes too little bone, or both loss and decreased production (NOF, 2018). This conditon causes bones to become extremely fragile, which increases the risk of fracture. Fractures can occur following a fall or injury, or in severe cases even from a minor bump to the area (NOF, 2018). Osteoporotic bones have a honeycomb appears due to the loss in bone density. For women over 50, the risk of osteoporosis increases and the provider should order a bone density scan to monitor the structure of the bone. Bone density scans are the only diagnostic testing for osteoporosis prior to a broken bone (NOF, 2018). The diagnostic test for bone density is done through x-ray called a Dexa Scan. Dexa stands for dual energy x-ray absorptiometry. (NOF, 2018). Dexa scans should be conducted every 1-2 years depending on patient history and risk factors. The Dexa scan results are determined by a T-score. Normal T-score results are -1.0 and anything above -1.0 are mild to severe osteoporosis (NOF, 2018). One of the medications used to treat osteoporosis is Actonel. Actonel is an oral medication that is taken daily. The mediation is designed to slow bone loss and even help to prevent fractures. (Actonel, 2017). One of the side effects that needs to be discussed with patients is that is can cause GI upset, so it the patient has a history of GI issues, another medication is most likely the better option.
