What are the high-yield strategies for family medicine residents to approach preventive medicine for patients of all ages and risk profiles?

High-Yield Preventive Medicine Guidelines for Family Medicine Residents

Core Preventive Visit Structure

Family medicine residents should prioritize comprehensive annual preventive visits over brief "sports physicals," as the latter lack essential psychosocial screening and miss opportunities for early diagnosis of conditions causing significant morbidity and mortality. 1, 2, 3

Essential Components of Every Preventive Visit

• Blood pressure measurement at every visit using proper technique with age-appropriate cuff size 1, 3
• Annual depression screening starting at age 11 through 21 years, as suicide is a leading cause of adolescent death 1
• Mandatory confidential time alone with adolescents (starting around age 12) to address sensitive topics including substance use, sexual activity, and mental health—nearly 1 in 4 adolescent boys report being too embarrassed to discuss important health issues when parents are present 1, 3

Age-Specific Screening Priorities

Children (Ages 8-12)

• Comprehensive developmental assessment including physical, cognitive, motor skills, and language development using validated tools like Ages and Stages Questionnaire or Pediatric Symptom Checklist 2
• Trauma exposure screening by asking "Has anything scary or concerning happened to you or your child since the last visit?" 2
• Lipid panel screening between ages 9-11 due to the growing obesity epidemic 1
• Assessment for signs of physical abuse or neglect during every examination 2

Adolescents (Ages 13-17)

• CRAFFT screening questionnaire for drug and alcohol use at every visit 1
• Sexual health screening including number of partners, contraception use, STI history, and discussion of consent and healthy relationships 1, 3
• HPV vaccination with strong recommendation emphasizing cancer prevention—normalize by coadministering with other vaccines 1
• Tdap booster if not previously given at age 11-12 1
• Annual influenza vaccine 1

Young Adults (Age 18+)

• Pap testing initiation if sexually active or at age 18 3
• STI screening for all sexually active patients 3
• Preconception counseling starting at puberty for all individuals of childbearing potential 1
• Transition planning to adult healthcare providers with education on personal health history and healthcare navigation 3

Contraception Counseling (All Reproductive Ages)

Use a tiered counseling approach presenting the most effective contraceptive options first, and prescribe one year's supply of hormonal contraceptives when selected to reduce barriers to use. 4

• Discuss all contraceptive methods that can be used safely regardless of whether available on-site and regardless of patient age or parity 4
• Physical assessment limited to blood pressure before starting hormonal contraceptives or pelvic examination before IUD placement 4
• Start any contraceptive immediately if reasonably certain patient is not pregnant 4
• Make condoms readily available in the practice 4
• Support advance provision of emergency contraceptives 4
• Continue contraceptive counseling until menopause or at least until age 50-55 years 4

Falls Prevention (Adults ≥65 Years)

Recommend exercise or physical therapy and vitamin D supplementation (at least 800 IU daily) for community-dwelling adults 65 years or older at increased risk for falls. 4

• Screen annually by asking all older adults about falls 4
• Assess gait and balance using standardized tests for those with fall history 4
• Medication management including withdrawal or minimization of psychoactive medications 4
• Home environment modification and management of postural hypotension 4
• Vision screening alone has insufficient evidence as a single intervention 4

STI Screening and Treatment

Provide high-intensity behavioral counseling for sexual risk reduction to all sexually active adolescents and adults at increased risk (current STD, STD in past year, multiple partners, nonmonogamous relationships, or living in high-STD-rate community). 4

Treatment Protocol

• Directly observe treatment in the facility rather than prescribing for pharmacy pickup 4
• Rescreen at 3 months after treatment for chlamydia or gonorrhea 4
• Expedited partner therapy (EPT) for chlamydia when partners cannot access care timely, where permissible by state law 4
• Bring partners in for gonorrhea treatment due to resistance concerns—EPT only as last resort 4

Cardiovascular Risk Screening

• Lipid panel screening if family history of hyperlipidemia or cardiovascular disease, or if not previously screened between ages 9-11 1, 3
• Blood pressure percentile tracking with lifestyle interventions and 6-month recheck if ≥90th percentile 1

Safety and Injury Prevention

Emphasize unintentional injury prevention as the leading cause of adolescent death through counseling on seatbelt use, helmet use for sports/cycling, avoidance of distracted and drunk driving, and firearm safety. 1, 2

• Water safety education for children 2
• Bicycle helmet use for all ages 2
• Booster seat/car seat compliance for children 2

Lifestyle Counseling

• Recommend 60 minutes of moderate to vigorous physical activity daily for children and adolescents 1, 2
• Recommend 30 minutes of moderate-intensity physical activity most days for adults 3
• Limit saturated fat to <10% of energy (ideally <7%) and minimize trans-fatty acids 3
• Promote diet rich in fruits, vegetables, whole grains, and high-fiber foods 3
• Limit sugar-sweetened beverages 1, 2
• Screen for eating disorders and body image concerns 1
• Assess sleep patterns: 8-10 hours for school-age children, adequate sleep hygiene for all ages 2

Common Pitfalls to Avoid

• Never substitute brief sports physicals for comprehensive examinations—this lacks psychosocial screening, confidentiality, and misses critical screening opportunities 1, 2, 3
• Never skip annual depression screening starting at age 11 1
• Never defer HPV vaccination—give strong recommendation and normalize by coadministering with other vaccines 1
• Never fail to provide confidential time with adolescents—this results in missed screening for risky behaviors causing significant morbidity and mortality 1, 3
• Never focus only on physical health while neglecting behavioral and developmental aspects 2
• Never rely solely on parental report without engaging the child directly 2

Documentation Requirements

Document patient understanding of contraceptive use, benefits, and risks, plus an individualized follow-up plan for all contraceptive visits. 4

• Record both parental and child concerns separately during pediatric visits 2
• Verify treatment administration when referring for STI treatment to sites with on-site medication 4