Recommended Laboratory Tests and Interventions for Annual Primary Care Visits
Based on current guidelines, annual primary care visits should include comprehensive medical history, physical examination, and specific laboratory tests tailored to age, sex, and risk factors. 1
Core Laboratory Tests for All Adults
- Complete blood count (CBC) with differential to screen for anemia, infection, and blood disorders 2
- Comprehensive metabolic panel (CMP) to assess kidney function, liver function, and electrolyte balance 2
- Lipid profile, including total cholesterol, LDL, HDL, and triglycerides, to assess cardiovascular risk 2, 3
- Hemoglobin A1C to screen for diabetes and prediabetes 2, 3
- Urinalysis with albumin-to-creatinine ratio to screen for kidney disease and urinary tract infections 2
- Blood pressure measurement at every visit 3
Age and Risk-Based Screening
Diabetes Screening
- For adults with BMI ≥25 kg/m² (≥23 kg/m² in Asian Americans) with one or more risk factors: annual testing 3
- Risk factors include: first-degree relative with diabetes, high-risk race/ethnicity, history of cardiovascular disease, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, polycystic ovary syndrome, physical inactivity 3
- For patients with prediabetes (A1C 5.7-6.4%): yearly testing 3
- For all other adults: begin testing at age 35, repeat every 3 years if normal 3
Cardiovascular Screening
- Annual blood pressure check for all patients 3
- Fasting lipid profile every 6-12 months, or every 1-3 months after starting or modifying antiretroviral therapy 3
- Consider abdominal ultrasonography once for men aged 65-75 years who have ever smoked 3
Infectious Disease Screening
- Annual syphilis, gonorrhea, and chlamydia testing for patients at risk for STDs 3
- Annual hepatitis C testing for patients at risk (e.g., injection drug users, MSM) 3
- Annual trichomoniasis testing for all women 3
- Tuberculosis testing (TST or IGRA) at baseline and annually for patients at risk 3
Cancer Screening
- Colorectal cancer screening starting at age 50 for average-risk patients 3
- Annual mammography for women age ≥50 years 3
- Annual cervical Pap smear for women after 2 normal Pap tests during the first year following HIV diagnosis 3
Special Considerations for Older Adults
- Thyroid-stimulating hormone (TSH) testing is particularly important for women and older adults 2, 4
- Bone densitometry for postmenopausal women and men age ≥50 years 3
- Consider functional performance assessment for adults ≥65 years 3
- Screening for cognitive impairment in older adults with risk factors 3
- For older adults with cognitive or behavioral symptoms, obtain structural brain imaging (MRI preferred, or CT if MRI is contraindicated) 3
Medication-Specific Monitoring
- Vitamin B12 levels for patients on metformin 3, 2
- Serum potassium levels for patients on ACE inhibitors, ARBs, or diuretics 3, 2
Preventive Health Counseling
- Diet and nutrition guidance 1
- Physical activity recommendations 1
- Tobacco cessation counseling 1
- Alcohol and substance use counseling 1
- Depression, anxiety, and disordered eating screening 3, 1
Common Pitfalls to Avoid
- Failing to consider patient-specific risk factors when determining which tests to order 2
- Under-screening obese patients for diabetes and dyslipidemia, particularly younger patients (35-44 years) with BMI 30-35 kg/m² 5
- Lower screening rates for women compared to men, despite similar risk profiles 5
- Overlooking the need for more frequent monitoring in patients with chronic conditions 2
- Neglecting to screen for thyroid disease in women 6
By following these evidence-based recommendations, primary care providers can ensure comprehensive preventive care that addresses the most important health risks while avoiding unnecessary testing.