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7/31/2019 Womens Health Promotion
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8/29/12
WomensHealthPromotionWhat all women need.
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Objectives
Why was chosen and what have othersdone to attempted to address.
Implementation
evaluation of interventions
reflections of how project went.
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Why this?
As a woman, it can be confusing to keep trackof all the screenings and tests you need,particularly as you get older.
INSURANCE!!
Women dont know what they need or when
Make them their own advocates!
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Addressing in pastGovernment public health insurance
Work wellness programsPamphlets/advertisement
Free testing and screening
Women and the Affordable Care Act
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ProgramsBreast and Cervical Cancer Screening CDC
provides high-quality screening and diagnosticservices to detect breast and cervical cancer atthe earliest stages through the National Breastand Cervical Cancer Early Detection Program(NBCCEDP). The program helps low-income,uninsured, and underinsured women (ages 40-64
years), gain access to breast and cervical cancerscreening and diagnostic services.
DES Exposure Research shows that womenexposed to diethylstilbestrol (DES) in utero (DES
Daughters) were at increased risk of thedevelo ment of clear cell adenocarcinoma of the
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ProgramsGynecologic Cancer Awareness Help raise
awareness of the five main types of gynecologic
cancer: cervical, ovarian, uterine, vaginal, andvulvar. When gynecologic cancers are foundearly, treatment is most effective. Know thecentral messages of the campaign, and use the
fact sheets to increase awareness.Sun Protection Exposure to the sun's ultraviolet
(UV) rays appears to be the most importantenvironmental factor involved in the
development of skin cancer. When usedconsistently, sun-protective practices can
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ProgramsEvery Woman's Life (EWL) is a public
health program that helps uninsured, low
income women gain access to free breastand cervical cancer screening services.Screening and early detection reducesdeath rates, improves treatment options,
and greatly increases survival. Insome sites where EWL services areoffered, women can also be screened forhigh blood pressure, cholesterol, andglucose and also learn how to become
more physically active, eat healthier
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Government helpSpecial Supplemental Nutrition Program for
Women, Infants, & Children (WIC). Provides
healthy foods to supplement diets, nutritioneducation, and referrals to health care for low-income women, infants, and children up to age 5.
National Breast and Cervical Cancer Early
Detection Program (NBCCEDP). Provides freeor low-cost mammograms and pap tests forwomen over age 39 who cannot afford breastexams or Pap smears.
Maternal and Child Health Services. State-
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Public Health
The government also provides health carecoverage for qualifying women throughMedicaid, Medicare, and special interestprograms. These plans serve those who meet
certain financial, age, or situationalrequirements. Government health insuranceprograms include:
Medicare. This is the national health insurance
program for people age 65 or older, under age65 with certain disabilities, and any age withpermanent kidney failure. How you get yourhealth care coverage depends on the Medicareplan you select.
The Ori inal Medicare Plan has three arts:
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Public HealthSome people also choose to purchase a
"Medigap" policy to help pay for medical
services and supplies not covered by Part Aand Part B. Costs for this type of privateinsurance vary by policy and company.
Medicare also offers Medicare
Advantage Plans.These are health planslike HMOs and PPOs that are approved byMedicare and run by private companies.
They are part of the Medicare Program,
and sometimes called Part C. Theseplans provide all of your Part A and Part B
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Public Health
Medicaid. Medicaid provides health care tocertain low-income individuals and families withlimited resources. Medicaid does not pay moneyto you. Instead, it sends payments directly to
your health care providers. Medicaid is a stateand federally funded program. Although thefederal government sets general program rules,each state defines its own eligibility rules and
runs its own program services. Qualification inone state does not mean you will qualify inanother state. You must be a U.S. national, citizenor permanent resident alien in order to apply forbenefits.
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Uninsured and do notqualify?
Some uninsured women make too much money toqualify for government assistance but cannotafford to pay for health insurance or costly medicalcare. This is a difficult situation for women and
their families. There are options for women in thissituation, including:
Free clinics. Free clinics provide services for theworking poor and uninsured. Usually, people whoqualify for Medicare, Medicaid or who can affordprivate insurance do not qualify for care in freeclinics. The Free Clinic Foundation of Americapublishes a National Directory of Free Clinics.Prescription drug assistance. Some states provideprescription drug assistance to women who are notcovered by Medicaid. Also, many drug companies will
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Cont.Women with HIV. The federal Ryan
White CARE Act funds services for those
with HIV/AIDS who have little or noinsurance and limited income. Low-costhealth insurance options. Some laborunions, professional clubs, associations,
and organizations offer private grouphealth insurance to its members. Theseplans usually are less costly and may bean option to consider.
State temporary insurance. Somewho have been denied health insurance
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Skin CancerCheck for skin changes once a month.
Show any suspicious or changing areas
to your doctor
Cancer-Related Checkup (including skinexam) for people at high risk:
Over 20: every 3 years
Over 40: every year
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Breast Cancer
u
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Breast Canceru
Women 20+ Breast self-examination(BSE)
It is acceptable for women to choose notto do BSE or to do BSE regularly(monthly) or irregularly. Beginning in theirearly 20s, women should be told about
the benefits and limitations of breast self-examination (BSE). Whether a womanever performs BSE, the importance ofprompt reporting of any new breastsymptoms to a health professional should
be emphasized. Women who choose to doBSE should receive instruction and havetheir technique reviewed on the occasionof a periodic health examination
Clinical breastexamination
For women in their 20s and 30s, it isrecommended that clinical breastexamination (CBE) be part of a periodichealth examination, preferably at leastevery three years. Asymptomatic womenage 40 and older should continue to
receive a clinical breast examination asart of
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Breast CancerSome women because of their family
history, a genetic tendency, or certain
other factors should be screened withMRI in addition to mammograms. (Thenumber of women who fall into thiscategory is small: less than 2% of all the
women in the US.) Talk with your doctorabout your history and whether youshould have additional tests at an earlierage.
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Popu Test or procedure frequency
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Colorectal CancerPopu. Test or procedure frequency
Women50+
Fecal occult bloodtest(FOBT) with at least50%
test sensitivity forcancer, orfecalimmunochemical test(FIT) with at least
50% testsensitivity for cancer,or
Annual, starting at age 50. Testing at homewith adherence to manufacturersrecommendation for collection techniques andnumber of samples is recommended. FOBT
with the single stool sample collected on theclinicians a fingertip during a digital rectalexamination in the health care setting is notrecommended. Guaiac based toilet bowl FOBTtests also are not recommended. Incomparison with guaiac-based tests for thedetection of occult blood, immunochemicaltests are more patient-friendly, and are likelyto be equal or better in sensitivity andspecificity. There is no justification forrepeating FOBT in response to an initialpositive finding.
Stool DNA test, or Interval uncertain, starting at age 50Flexiblesigmoidoscopy(FSIG), or
Every 5 years, starting at age 50. FSIG can beperformed alone, or consideration can begiven to combining FSIG performed every 5years with a highly sensitive gFOBT or FITperformed annually.
Double contrast Every 5 years, starting at age 50
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Colorectal CancerTests that primarily find cancer
Yearly fecal occult blood test (gFOBT)*,**,or
Yearly fecal immunochemical test (FIT)every year*,**, or
Stool DNA test (sDNA)**** If the test is positive, a colonoscopyshould be done.
** The multiple stool take-home test shouldbe used. One test done by the doctor in theoffice is not adequate for testing. A
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Colorectal CancerThe tests that are designed to find both
early cancer and polyps are preferred if
these tests are available to you and youare willing to have one of these moreinvasive tests. Talk to your doctor aboutwhich test is best for you.
Some people should be screened using adifferent schedule because of theirpersonal history or family history. Talkwith your doctor about your history andwhat colorectal cancer screeningschedule is best for you.
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Cervical CancerCervical cancer screening (testing)
should begin at age 21. Women under
age 21 should not be tested.
Women between ages 21 and29 should have a Pap test every 3 years.Now there is also a test called the HPV
test. HPV testing should not be used inthis age group unless it is needed afteran abnormal Pap test result.
Women between the ages of 30 and
65 should have a Pap test plus an HPV -
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Population Test/procedure
Frequency
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Population Test/procedure Frequency
Women21+
Pap test PaptestHPV DNA
test
Cervical cancer screening shouldbegin approximately three years aftera woman begins having vaginal
intercourse, but no later than 21years of age. Screening should bedone every with conventional Paptests or every two years using liquid-based Pap tests. At or after age 30,women who have had three normaltest results in a row may undergoscreening every two to three yearswith cervical cytology (either
conventional or liquid-based Pap test)alone, or every three years with anHPV DNA test plus cervical cytology.Women 70 years of age and olderwho have had three or more normal
Pap tests and no abnormal Pap tests
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Endometrium CancerPopulation Tests/procedures
Women, at
menopause
At the time of
menopause, women ataverage risk should beinformed about risksand symptoms of
endometrial cancerand stronglyencouraged to reportany unexpectedbleeding or spotting to
their physicians.
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Endometrium CancerThe American Cancer Society
recommends that at the time of
menopause, all women should be toldabout the risks and symptoms ofendometrial cancer. Women shouldreport any unexpected bleeding orspotting to their doctors.
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Osteoporosis Screening
DXA Scanning (Bone-Density Testing) For women ages 65 and over, and after
menopause in women with additional riskfactors.Frequency Every 2 years, but varies.
http://www.huntingtonorthopedics.com/_media/images/osteoporosis.jpg
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Lipids/CholesterolAll adults age 20 or older should have a
fasting lipoprotein profile which
measures total cholesterol, LDL (bad)cholesterol, HDL (good) cholesterol andtriglycerides once every five years.
This test is done after a nine- to 12-hour
fast without food, liquids or pills. It givesinformation about total cholesterol, LDL(bad) cholesterol, HDL (good) cholesteroland triglycerides.
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Blood PressureCheck yearly, every age
Diabetic Screen
Fasting plasma glucose (preferred) orrandom plasma glucose
For women ages 45 and over
Frequency Every 3 years
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DentalCheck yearly, every age
Vision
check early on if problems noticed insmall children, basic eye exam inkindergarten, and every 1-2 years asneeded. If glasses, diabetic, htn, needevery year!
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ImmunizationsHuman Papilloma Virus (HPV) Vaccine
(Gardasil for Cervical Cancer)
For all females between ages 11 and 26
Frequency One series of 3 vaccines
Influenza (for Flu)
Frequency Annually, in order ofpriority, for:
1. women at high risk due to
diabetes, or heart, lung, kidney orimmune system disease
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ImmunizationsPneumococcal (for Pneumonia)
All women age 65 and over
Frequency One time only
For women at high risk due to diabetes,cancer, or heart, lung or immune system
diseaseFrequency Initial vaccination, followed by
one revaccination 5 years later
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EducationFor all Adult and Adolescent Females
Smoking Cessation
Alcohol and Drug Abuse Prevention
Seat Belt Safety
Safe Sex Practices
Nutrition and Exercise
Firearm Safety
For women entering, during, or after
menopause
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ImplementationGo over Prevention Checklist for Women
at first visit and yearly, keep in their file.
Pamphlets make sure they get one yearlywith a card. Review the check list yearly!
Review individual reminder papers on front ofthe chart each year and update.
Educate, educate, educate!!
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Implementation
Discussed pamphlet with patients to see ifthey would find this helpful.
Patients liked this and were requesting acard/pamphlet after I showed them.
Discussed idea with preceptors theyapproved the idea and liked the format.
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EvaluationWill require a budget somewhere to
print pamphlets and cards.
Will require women who are cognitivelyable to read, write, and decent memory.
Useful to quickly review a wellnessvisit.
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ReflectionsWomen must want to be a part of their
health care for this to work.
This will make them more aware of theirhealth and feel more in control.
With as techno-savy as we are today, wemay not need this in the future. Someplaces are still not all computerized.
EDUCATION is important. Every womanstill needs to know what she needs eachyear.
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ReferencesAmerican Cancer Society. (2012). Cervical Cancer.Retrieved
http://www.cancer.org/Cancer/CervicalCancer/inde\x
Beckmann, R.B., Ling, F.W., Barzansky,
B.M.,Herbert, D.W., Laube, D.W., & Smith,R.P.(2010). Obstetrics andGynecology 6th ed. Philadelphia: Lippincott
WIlliams & Wilkins.