Primary and preventive care: periodic assessments.

Periodic assessments offer an excellent opportunity for obstetricians and gynecologists to provide preventive screening, evaluation, and counseling. The American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice recommends routine assessments in primary and preventive care for women based on age and risk factors. Committee on Gynecologic Practice This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. ACOG COMMITTEE OPINION The American College of Obstetricians and Gynecologists Women’s Health Care Physicians The following charts are updated versions of those previously published by the American College of Obstetricians and Gynecologists (ACOG) in Committee Opinion No. 357 and Guidelines for Women’s Health Care, Third Edition. This version replaces the previous versions. The policies and recommendations of ACOG committees regarding specific aspects of the health care of women have been incorporated; they may differ from the recommendations of other groups. The American College of Obstetricians and Gynecologists recommends that the first visit to the obstetrician–gynecologist for screening and the provision of preventive health care services and guidance take place between the ages 13 years and 15 years. This visit will provide health guidance, screening, and preventive health care services and provide an excellent opportunity for the obstetrician–gynecologist to start a physician–patient relationship. This visit does not necessarily include an internal pelvic examination. Periodic assessments provide an excellent opportunity to counsel patients about preventive care. These assessments, yearly or as appropriate, should include screening, evaluation and counseling, and immunizations based on age and risk factors. Personal behavioral characteristics are important aspects of a woman’s health. Positive behaviors, such as exercise, should be reinforced, and negative ones, such as smoking, should be discouraged. The following guidelines indicate routine assessments for nonpregnant women based on age groups and risk factors (see Table 1) and list leading causes of death for each age group. The American College of Obstetricians and Gynecologists generally adopts the immunization recommendations of the Centers for Disease Control and Prevention. The current adolescent and adult immunization schedules are available atwww.cdc.gov/vaccines/recs/ schedules. The recommendations included in this document serve as a framework for care, which may be provided by a single physician or a team of health care professionals. The scope of services provided by obstetrician– gynecologists in the ambulatory setting will vary from practice to practice. The list should serve as a guide for the obstetrician–gynecologist and others providing health care for women and should be adapted as necessary to meet patients’ needs. For example, certain risk factors may influence additional assessments and interventions. Physicians should be alert to high-risk factors (indicated by an asterisk and further elucidated in Table 1). During evaluation, the patient should be made aware of high-risk conditions that require targeted screening or treatment. Number 452 • December 2009 (Replaces No. 357, December 2006)