BACKGROUND: Wellness span all categories such as health promotion, disease prevention and health maintenance. It is not merely an extensive executive check up. Health maintenance improves delivery of recommended preventive services, and may lessen patient worry. It is also a chance for physicians to strengthen their relationship. Physicians may use this time to discuss issues such as family relationships. The adult wellness recommendations should be evidence-based to gear towards optimal health and well-being in a cost-effective manner.
METHODS: The PAFP Clinical Pathways Group reviewed published clinical practice guidelines and medical literature to identify, summarize, and operationalize the content of the following: history, physical examination, tools for comprehensive geriatric assessment, screening for risk factors, pharmacologic and non-pharmacologic interventions. Indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice were identified.
RECOMMENDATIONS: Recommendations were made based on the number of visits. During the first visit, all adult patients consulting at the clinic for wellness should have a thorough history, physical examination and screening for risk factors. The laboratories to be requested will depend on these risk factors. For immunization, the following maybe given: influenza, varicella, MMR, Tdap, Hepatitis B and Human papilloma virus vaccines. Patients should be educated on appropriate diet and physical activities. Interventions to promote smoking cessation and moderate alcohol drinking should be done. Health maintenance through regular clinical visits should be advocated. Family members should also be motivated to adhere to wellness recommendations.
IMPLEMENTATION: Education, training and audit are recommended strategies to implement the clinical pathway for adults 19-59 years old.