Michelle Greiver, M.D., C.C.F.P.
240 Duncan Mill road, suite 705
Toronto, Ontario M3B 3S6
Fax: (416) 221-3097
The Preventive Health Tables
I have found that keeping track of what preventive measures I actually offer to my patients has been a problem. As well, it has been difficult for me to remember all the interventions that I am supposed to do (there are over 20 recommended interventions for a 50 year old man!) To try to solve this problem, I wrote tables that I can print and put in my patient files.
The Tables contain all the Canadian and US Preventive Task Forces grade A (good evidence for inclusion) and grade B (fair evidence for inclusion) recommendations. The country of origin is indicated (CAN for Canadian, or US). If there is no country of origin indicated on a Table, both Task Forces have recommended it. When a risk calculation is recommended (such as the Framingham equation when considering ASA, or the Gail Model to select patients for prevention of breast cancer with Tamoxifen), I've provided a link to an on-line calculator, as well as to a relevant patient handout.
The Tables are used on all my charts; I put them behind the Cumulative Patient Profile. I write the patient's name on top, along with the date initially filled, and dates reviewed. I check off each maneuver as it is done, and circle those that need revisiting. This offers an easy and organized method of both improving the provision of preventive services, and of keeping track of what has been done for each patient. It is not necessary to fill an entire table at the first complete check-up; the tables can be completed over time. After more than four years of using this approach, I find that most of the recommended maneuvres have been done, for almost all of my patients; my "annual check-ups" are now much closer to becoming Preventive Health Examinations.
The tables were originally published in the November 1999 issue of Canadian Family Physician. They were also presented as an abstract at the CFPC Family Medicine Forum 2000 Conference. I update the tables periodically, when new recommendations are published.
Suggestions for changes and improvements are definitely welcome!
Here are the tables:
6 to 10
Ages 11 to 24
Ages 25 to 64
Age 65 and Over