women’s health promotion

7/31/2019 Womens Health Promotion

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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.

women’s health promotion

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