By Rebecca Bowers

EXECUTIVE SUMMARY

A new committee opinion issued by the American College of Obstetricians and Gynecologists, in conjunction with the Women’s Preventive Services Initiative’s rollout of a “Well-Woman Chart,” is designed to help clinicians follow the latest updates for preventive care.

  • The chart includes guidance from the Women’s Preventive Services Initiative, as well as recommendations from the U.S. Preventive Services Task Force and Bright Futures. The chart is organized according to age groups and categorizes services by general health, infectious diseases, and cancer.
  • In addition to a comprehensive review of a woman’s reproductive health, the well-woman visit is a good time for counseling patients about following a healthy lifestyle and limiting health risks.

In the past decade, clinicians have seen many changes to the recommendations for women’s preventive care. A new committee opinion issued by the American College of Obstetricians and Gynecologists (ACOG), in conjunction with the Women’s Preventive Services Initiative’s rollout of a “Well-Woman Chart,” is designed to help clinicians follow the latest updates about preventive care.1 (Access the chart in infographic form at https://bit.ly/2F27q3c, and visit the Women’s Preventive Services Initiative’s web site at www.womenspreventivehealth.org for more details and clinical summaries.)

The two resources are designed to aid clinicians in addressing the individual needs of each patient more comprehensively, says Christopher Zahn, MD, ACOG’s vice president of practice activities. By offering a comprehensive source for preventive care recommendations for women, clinicians can ensure a timely, collaborative approach to patient care, he noted in a press statement.

Check the Chart

The Well-Woman Chart is designed as a tool that summarizes the recommendations for preventive services for women’s health. It includes guidance from the Women’s Preventive Services Initiative, a five-year cooperative agreement with the U.S. Department of Health and Human Services, Health Resources and Services Administration, and spearheaded by national health professional organizations and consumer and patient advocate groups. The chart also covers recommendations from the U.S. Preventive Services Task Force and Bright Futures. The chart is organized according to age groups and categorizes services by general health, infectious diseases, and cancer.

In addition to a comprehensive review of a woman’s reproductive health, the well-woman visit is a good time for counseling patients about following a healthy lifestyle and limiting health risks, the committee opinion states.1 These visits should cover screening, evaluation/counseling, and immunizations according to the patient’s age and risk factors.

The timing of certain services may vary according to the needs of individual patients, and the scope of services provided may differ according to the ambulatory care setting. A team-based approach by obstetrician-gynecologists, physician assistants, nurse practitioners, and other related healthcare professionals can address all the aspects of well-woman care.1

The new guidance indicates that a comprehensive health history is an essential part of the well-woman visit.1 Although not all aspects of a physical exam may be necessary at a particular visit, clinicians can use the encounter to engage in shared decision-making with patients, encourage healthy lifestyle behaviors, and counsel patients about effective preventive health practices.

Be sure to cover items such as symptoms, medications, and allergies, as well as medical, surgical, family, social, and gynecologic information when taking a patient history. Include questions on reproductive, sexual, and mental health, and use screening tools as indicated by ACOG and WPSI. By taking a comprehensive history, clinicians are able to determine if certain aspects of the physical examination, such as breast or pelvic examination, are indicated, and will allow shared decision-making for such exams. Also remember to check for items such as bone health, vulvovaginal symptoms, and sexual health at every well-woman exam, as well as screening and counseling for interpersonal and domestic violence.1

Because the Patient Protection and Affordable Care Act of 2010 identified preventive health services for women for required coverage without cost-sharing, women’s health specialists can assist women with health and well-being at several stages of life through recommended preventive services and counseling.

A women’s health professional may provide care for patients through various phases of their lives, from adolescence to reproductive years, through menopause, and beyond, said Zahn. The new resources help women’s healthcare providers manage the updates to well-woman care so that they can provide effective and appropriate care for their patients, he stated.

Review the Spectrum of Care

For women of reproductive age, a key part of a well-woman visit involves developing and discussing a reproductive plan to ensure that medical testing and treatments match a woman’s current and future plans. Such discussions may include prepregnancy counseling, infertility assessment, or the range of available contraceptive options.1

In addition to reviewing birth control options, the well-woman visit can cover cancer screening; vaccinations (including HPV, flu, and more); health screenings for high blood pressure, diabetes, and bone density; screening for depression; and screening for sexually transmitted infections.

The visit gives clinicians an opportunity to provide education, screening, and monitoring to help women reduce their risks from cardiovascular disease, such as myocardial infarction and stroke. Clinicians should screen all women for tobacco use and provide counseling regarding smoking cessation options as well as ways to address at-risk drinking and alcohol dependence, the committee opinion states. Be sure to screen women for overweight and obesity, and be prepared to counsel and offer treatment options or referrals, the guidance recommends.

Many women and clinicians focus the well-woman visit only on the woman, but consider that it is a perfect opportunity to talk to women about the health of their children, advises Susan Wysocki, WHNP-BC, FAANP, president and chief executive officer of iWomansHealth in Washington, DC, which focuses on information on women’s health issues for clinicians and consumers. Specifically, talk to women about the HPV vaccine for their preteen children, both female and male, she says. Also, consider that women who may not have children may have female friends who do; in some cases, an aunt, grandmother, or best friend could be a resource to a mother who has preteen children and may be unaware of the HPV vaccine, says Wysocki.

“Further, women often have questions about issues that affect the people in their care,” states Wysocki. “Clinicians can add value and a reason to come back for a well-woman visit if [patients] consider the visit as an opportunity to ‘ask an expert.’”

REFERENCE

  1. ACOG Committee Opinion No. 755: Well-woman visit. Obstet Gynecol 2018;132:e181-e186.