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Lifetime health monitoring plan
Lifetime health monitoring plan
A schedule of health goals with related professional services for certain periods of an individual’s life has been developed as an effective method for promoting good health and reducing health care costs. Reports on the new plan appear in the New England Journal of Medicine (March 17, 1977) and The Nation’s Health (May 1977). The “lifetime health monitoring plan” (LHMP) has been proposed by Lester Breslow, MD, dean of the School of Public Health at the University of California at Los Angeles, and Anne Somers, associate professor of community medicine at the College of Medicine and Dentistry of New JerseyRutgers Medical School, New Brunswick. The plan divides the life span into ten periods and is “an exploratory proposal to be reviewed and refined by health professionals and knowledgeable consumers,” according to the authors. The LHMP program attempts to bring together epidemiologic and clinical approaches to health maintenance. Somers and Dr Breslow point out that the two approaches have many similarities, including a focus on continuing, personal health service; identification of specific preventive measures for specific age groups: and use of educational and counseling techniques to influence individual health-related behavior and specified testing procedures to ascertain early onset of disease or the presence of certain disease risk factors. LHMP calls for considerable use of nonphysician health care practitioners and could cost as as little as $7.50 per year “if done on
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a team basis and built into health insurance so it can be costed out,” Somers stated. The services would be provided by a primary health care team of a physician, a clinically oriented practitioner, and a behaviorally oriented practitioner. Somers suggested that some kind of core curriculum would be needed to allow health care professionals to learn more than their own discipline. It is hoped that a program such as LHMP will reduce the need for expensive curative care by using long-range preventive health care. Somers and Dr Breslow point out, however, that the savings will not show up immediately but only in the years to come. “The primary object of preventive care,” Somers and Dr Breslow stress, “is not to save money but to save lives, to avoid p r e mature death, and to improve the quality of life.” Underfinancing of preventive health care insurance programs and the question of individual participation in such a program are two problems that face the lifetime health monitoring plan. Health insurance leaders have voiced an interest in LHMP, however, and suggest introducing it to the public first on a moderate scale. Proponents of lifetime health monitoring believe there are certain incentives that could be built into the program to encourage its acceptance. For the consumer, financial benefits for pursuing preventive medicine and dentistry could be included in current health insurance policies. Discussing professional acceptance of LHMP, Somers and Dr Breslow state, “What is needed most of all is
AORN Journal,October 1977,Vol26, N o 4
Pregnancy and perlnatal period 1. advance education and counseling concerning childbearing, infant care, and family planning for first-time parents 2. medical care before and after birth for mother and baby; educatioWcounseling for both parents 3. delivery services, including specialized perinatal care as needed Infancy (first year) 1. tests for metabolic and congenital disorders prior to discharge from hospital; parent counseling 2. four postdischarge physician’s visits with healthy baby for observation, specified immunizations, and parent counseling
Preschool child (1 to 5 years) 1. two physician’s visits with healthy child and mother (father also, ideally) at age 2 to 3 years and when starting school for compliance with immunization schedule as well as for observation and counseling on nutrition, vision, hearing, speech, dental health, accident prevention, activity, and general physical, emotional, and social development 2. blood tests for anemia, lead poisoning, and tuberculosis for high-risk groups School child (6 to 11 years) 1. two visits with healthy child (at ages 6 to 7 and 9 to lo), including one complete physicaVmentaVbehavioraVsocia1 examination. Tests for and observation of any physical or mental impairment: obesity, vision, hearing defects, muscular incoordination, and learning disabilities; completion of necessary immunizations 2. mandatory school health education and individual counseling as needed for nutrition, exercise, study, accident prevention, physical fitness, sexual development, and use of cigarettes, drugs, alcohol 3. annual dental examination and prophylaxis
730
Adolescence (12 to 17 years) 1. mandatory school health education and individual counseling as needed, including a course in sex, marriage, and family relations as prerequisite to high school graduation 2. one visit with healthy teenager (at about age 13) for checks on emotional status, vision and hearing, skin, blood pressure, blood cholesterol, and contraception 3. annual dental exam and prophylaxis Young adulthood (18 to 24 years) 1. visit with the healthy adult, including complete physical examination; tetanus booster (if none received within ten years); tests for syphilis, gonorrhea, malnutrition, cholesterol, and hypertension; medical and behavioral history; visit to take place before marriage 2. health education, individual counseling as needed 3. dental examination and prophylaxis every two years Young middle age (25 to 39 years) 1. two visits with healthy person at about 30 and 35.Tests for hypertension, anemia, cholesterol, cervical and breast cancer, and instruction on self-examination of breast, testes, skin, neck, and mouth 2. counseling concerning nutrition, exercise, alcohol, smoking, and health-related behavior and lifestyle 3. dental examination and prophylaxis every two years Older middle age (40 to 59 years) 1. four visits, once every five years-about 40, 45, 50,and 55-including complete physical examination and medical history; tests for chronic conditions; immunizations; and counseling 2. annual tests for obesity, hypertension, and certain cancers for those over 50 3. annual dental prophylaxis The elderly (60 to 74 years) 1. professional visit at age 60 and every two years thereafter; same tests for chronic
AORN Journal, October 1977,Vol26, No 4
conditions as in middle age; counseling concerning retirement, nutritional requirements, absence of children, possible loss of spouse, and probaS:e reduction in income and physical resources 2. annual immunization against influenza (unless allergic to vaccine) 3. annual dental prophylaxis 4. periodic podiatry treatments as needed Old age (75 years and over) 1. annual professional visit, including complete physical exam, medical and behavioral history; counseling regarding nutritional requirements, limitations on activity, mobility, and living arrangements 2. annual influenza immunization (unless allergic to vaccine) 3. periodic dental and podiatry treatments as needed 4. for low-income and others not sick enough to be institutionalized but not well enough to cope entirely alone, counseling concerning sheltered housing, health visitors, home helps, day care and recreational centers, meals-on-wheels, and other measures 5. professional assistance with family relations and preparations for death, if needed Adapted from New EnglandJournal of Medicine (March 17, 1977) 602-605. a more positive view of prevention on the part of the medical profession, which sets the tone for the attitudes of other health professionals and consumers as well.” They believe that the present fee-for-service health care system can be adapted to lifetime health monitoring because it “has shown itself reasonably flexible and capable of assimilating preventiowat least at the primary-care level, where it is most relevant.”
Diagnostic x-rays genetically harmful “There is clear prima facie evidence that exposure to the low levels of ionizing radiation can produce a drastically increased risk of leukemia and other diseases in the children of persons exposed to these levels.” This was the conclusion of Irwin D J Bros9, PhD, and N Natarajan from their studies at Roswell Park Memorial Institute in Buffalo, NY. In recent years, the incidence of leukemia has been 21,000 per year. For the minority of exposed persons (about 1%) who are affected by the radiation, there is a =-fold increase in the risk of leukemia and a Bf d d increase in certain other diseases, Bross reports. “These findings refute a dogma that is often cited by radiologists who claim that diagnostic radiation is harmless,” he declares. In commenting on the Roswell Park study, medical authorities point out that benefits from low dosage diagnostic x-rays, which can determine in advance many serious medical problems related to childbirth, are substantial, and benefits must be weighed against risk. Damage from x-rays appears in 1% of the children in the study. It has been assumed that genetic damage is virtually eliminated by a process known as fractionation in which the total dose of radiation is administered in small doses at intervals. But, says Bross, “genetic damage still occurs even with fractionation. “Fractionation creates the illusion that the genetic damage has disappeared, when, in actuality, the genetic damage to the population is, if anything, increased.” When a mother is exposed to radiation during pregnancy, genetic damage occurs in only a small proportion of babies. This damage will later be expressed as increased risk of certain childhood diseases, such as leukemia, asthma, skin rash, eczema, pneumonia, dysentery, and rheumatic fever, Bross says.
AORN Journal, October 1977,Vol26, No 4
731
A schedule of health goals with related professional services for certain periods of an individual’s life has been developed as an effective method for promoting good health and reducing health care costs. Reports on the new plan appear in the New England Journal of Medicine (March 17, 1977) and The Nation’s Health (May 1977). The “lifetime health monitoring plan” (LHMP) has been proposed by Lester Breslow, MD, dean of the School of Public Health at the University of California at Los Angeles, and Anne Somers, associate professor of community medicine at the College of Medicine and Dentistry of New JerseyRutgers Medical School, New Brunswick. The plan divides the life span into ten periods and is “an exploratory proposal to be reviewed and refined by health professionals and knowledgeable consumers,” according to the authors. The LHMP program attempts to bring together epidemiologic and clinical approaches to health maintenance. Somers and Dr Breslow point out that the two approaches have many similarities, including a focus on continuing, personal health service; identification of specific preventive measures for specific age groups: and use of educational and counseling techniques to influence individual health-related behavior and specified testing procedures to ascertain early onset of disease or the presence of certain disease risk factors. LHMP calls for considerable use of nonphysician health care practitioners and could cost as as little as $7.50 per year “if done on
728
a team basis and built into health insurance so it can be costed out,” Somers stated. The services would be provided by a primary health care team of a physician, a clinically oriented practitioner, and a behaviorally oriented practitioner. Somers suggested that some kind of core curriculum would be needed to allow health care professionals to learn more than their own discipline. It is hoped that a program such as LHMP will reduce the need for expensive curative care by using long-range preventive health care. Somers and Dr Breslow point out, however, that the savings will not show up immediately but only in the years to come. “The primary object of preventive care,” Somers and Dr Breslow stress, “is not to save money but to save lives, to avoid p r e mature death, and to improve the quality of life.” Underfinancing of preventive health care insurance programs and the question of individual participation in such a program are two problems that face the lifetime health monitoring plan. Health insurance leaders have voiced an interest in LHMP, however, and suggest introducing it to the public first on a moderate scale. Proponents of lifetime health monitoring believe there are certain incentives that could be built into the program to encourage its acceptance. For the consumer, financial benefits for pursuing preventive medicine and dentistry could be included in current health insurance policies. Discussing professional acceptance of LHMP, Somers and Dr Breslow state, “What is needed most of all is
AORN Journal,October 1977,Vol26, N o 4
Pregnancy and perlnatal period 1. advance education and counseling concerning childbearing, infant care, and family planning for first-time parents 2. medical care before and after birth for mother and baby; educatioWcounseling for both parents 3. delivery services, including specialized perinatal care as needed Infancy (first year) 1. tests for metabolic and congenital disorders prior to discharge from hospital; parent counseling 2. four postdischarge physician’s visits with healthy baby for observation, specified immunizations, and parent counseling
Preschool child (1 to 5 years) 1. two physician’s visits with healthy child and mother (father also, ideally) at age 2 to 3 years and when starting school for compliance with immunization schedule as well as for observation and counseling on nutrition, vision, hearing, speech, dental health, accident prevention, activity, and general physical, emotional, and social development 2. blood tests for anemia, lead poisoning, and tuberculosis for high-risk groups School child (6 to 11 years) 1. two visits with healthy child (at ages 6 to 7 and 9 to lo), including one complete physicaVmentaVbehavioraVsocia1 examination. Tests for and observation of any physical or mental impairment: obesity, vision, hearing defects, muscular incoordination, and learning disabilities; completion of necessary immunizations 2. mandatory school health education and individual counseling as needed for nutrition, exercise, study, accident prevention, physical fitness, sexual development, and use of cigarettes, drugs, alcohol 3. annual dental examination and prophylaxis
730
Adolescence (12 to 17 years) 1. mandatory school health education and individual counseling as needed, including a course in sex, marriage, and family relations as prerequisite to high school graduation 2. one visit with healthy teenager (at about age 13) for checks on emotional status, vision and hearing, skin, blood pressure, blood cholesterol, and contraception 3. annual dental exam and prophylaxis Young adulthood (18 to 24 years) 1. visit with the healthy adult, including complete physical examination; tetanus booster (if none received within ten years); tests for syphilis, gonorrhea, malnutrition, cholesterol, and hypertension; medical and behavioral history; visit to take place before marriage 2. health education, individual counseling as needed 3. dental examination and prophylaxis every two years Young middle age (25 to 39 years) 1. two visits with healthy person at about 30 and 35.Tests for hypertension, anemia, cholesterol, cervical and breast cancer, and instruction on self-examination of breast, testes, skin, neck, and mouth 2. counseling concerning nutrition, exercise, alcohol, smoking, and health-related behavior and lifestyle 3. dental examination and prophylaxis every two years Older middle age (40 to 59 years) 1. four visits, once every five years-about 40, 45, 50,and 55-including complete physical examination and medical history; tests for chronic conditions; immunizations; and counseling 2. annual tests for obesity, hypertension, and certain cancers for those over 50 3. annual dental prophylaxis The elderly (60 to 74 years) 1. professional visit at age 60 and every two years thereafter; same tests for chronic
AORN Journal, October 1977,Vol26, No 4
conditions as in middle age; counseling concerning retirement, nutritional requirements, absence of children, possible loss of spouse, and probaS:e reduction in income and physical resources 2. annual immunization against influenza (unless allergic to vaccine) 3. annual dental prophylaxis 4. periodic podiatry treatments as needed Old age (75 years and over) 1. annual professional visit, including complete physical exam, medical and behavioral history; counseling regarding nutritional requirements, limitations on activity, mobility, and living arrangements 2. annual influenza immunization (unless allergic to vaccine) 3. periodic dental and podiatry treatments as needed 4. for low-income and others not sick enough to be institutionalized but not well enough to cope entirely alone, counseling concerning sheltered housing, health visitors, home helps, day care and recreational centers, meals-on-wheels, and other measures 5. professional assistance with family relations and preparations for death, if needed Adapted from New EnglandJournal of Medicine (March 17, 1977) 602-605. a more positive view of prevention on the part of the medical profession, which sets the tone for the attitudes of other health professionals and consumers as well.” They believe that the present fee-for-service health care system can be adapted to lifetime health monitoring because it “has shown itself reasonably flexible and capable of assimilating preventiowat least at the primary-care level, where it is most relevant.”
Diagnostic x-rays genetically harmful “There is clear prima facie evidence that exposure to the low levels of ionizing radiation can produce a drastically increased risk of leukemia and other diseases in the children of persons exposed to these levels.” This was the conclusion of Irwin D J Bros9, PhD, and N Natarajan from their studies at Roswell Park Memorial Institute in Buffalo, NY. In recent years, the incidence of leukemia has been 21,000 per year. For the minority of exposed persons (about 1%) who are affected by the radiation, there is a =-fold increase in the risk of leukemia and a Bf d d increase in certain other diseases, Bross reports. “These findings refute a dogma that is often cited by radiologists who claim that diagnostic radiation is harmless,” he declares. In commenting on the Roswell Park study, medical authorities point out that benefits from low dosage diagnostic x-rays, which can determine in advance many serious medical problems related to childbirth, are substantial, and benefits must be weighed against risk. Damage from x-rays appears in 1% of the children in the study. It has been assumed that genetic damage is virtually eliminated by a process known as fractionation in which the total dose of radiation is administered in small doses at intervals. But, says Bross, “genetic damage still occurs even with fractionation. “Fractionation creates the illusion that the genetic damage has disappeared, when, in actuality, the genetic damage to the population is, if anything, increased.” When a mother is exposed to radiation during pregnancy, genetic damage occurs in only a small proportion of babies. This damage will later be expressed as increased risk of certain childhood diseases, such as leukemia, asthma, skin rash, eczema, pneumonia, dysentery, and rheumatic fever, Bross says.
AORN Journal, October 1977,Vol26, No 4
731