Annual Wellness Visit Components
An annual wellness visit should include comprehensive preventive screenings, vital sign measurements, and age-appropriate assessments to optimize morbidity, mortality, and quality of life outcomes.
Core Components for All Patients
Vital Signs and Physical Assessment
- Blood pressure measurement 1
- Body mass index (BMI) calculation and plotting 1
- Waist circumference measurement 1
- Basic physical examination focusing on cardiovascular, respiratory, and neurological systems
Laboratory Testing
- Fasting lipid profile (total cholesterol, LDL, HDL, triglycerides) 1
- Comprehensive metabolic panel (including electrolytes, kidney function) 2
- Complete blood count (CBC) 3, 4
- Fasting blood glucose or HbA1c 1
- Urinalysis with microalbumin-to-creatinine ratio 1
Preventive Screenings
- Cancer screenings based on age and risk factors
- Immunization status review and updates
- Vision screening
- Hearing assessment
Age-Specific Components
Children and Adolescents
- Growth and developmental milestone assessment 5
- Age-appropriate immunizations
- For diabetic children:
Adults
- Cardiovascular risk assessment
- Bone density screening (for appropriate age groups)
- Depression screening
- Substance use assessment
- Fall risk assessment for older adults
Disease-Specific Components
Diabetes Management
- Annual eye examination 1, 6
- Annual comprehensive foot examination 1, 6
- HbA1c testing 6
- Microalbuminuria testing 1, 6
- Lipid profile assessment 1
Cardiovascular Disease
- Stress testing for patients with risk factors or symptoms
- Electrocardiogram for appropriate patients
- Detailed lipid profile analysis
Lifestyle and Risk Factor Assessment
- Dietary assessment 1
- Physical activity evaluation 1
- Smoking status and cessation counseling if applicable 1
- Alcohol and substance use screening
Common Pitfalls to Avoid
Over-testing: Avoid ordering unnecessary tests that don't change management or improve outcomes. Focus on evidence-based screenings appropriate for age and risk factors.
Under-testing: Annual wellness visits significantly increase the use of preventive services, especially in patients with chronic conditions like diabetes 6. Missing key screenings can lead to delayed diagnosis and poorer outcomes.
Failure to follow up: Ensure abnormal results have appropriate follow-up plans and referrals.
Not individualizing based on risk factors: High-risk patients may need more frequent or additional testing beyond standard annual screenings.
Missing opportunities for counseling: Use the visit to provide counseling on healthy lifestyle, including diet, exercise, and smoking cessation 1.
Efficiency Considerations
- Point-of-care testing can reduce wait times and improve efficiency when appropriate 2
- Prioritize tests that have the greatest impact on morbidity and mortality outcomes
- Coordinate care to avoid duplicate testing when patients see multiple specialists
By implementing these comprehensive components in annual wellness visits, providers can effectively monitor patient health, detect problems early, and implement preventive strategies to improve long-term health outcomes.