Adult Health Check

   

  • Aboriginal adults and over 18 years should have a health check every year to
    • Find problems before they get serious and to promote a healthy life
    • Give health education
  • An individual health check every year is especially important if person has
    • A history of diabetes in pregnancy or polycystic ovary syndrome
    • Mother/father, brother/sister with diabetes or early onset (under 50 years when diagnosed) kidney failure or heart attack
    • Pre-diabetes or microalbuminuria
    • Changes in BP or blood fats but low cardiovascular risk factors 
    • Obesity

Doing an Adult Health Check

  • Health checks find out what is important for the person, their concerns and goals for health. It is important to follow-up results from the check
  • There are different health checks for Aboriginal and non-Aboriginal people. These are based on prevalence of  (how many people in the population have) chronic conditions 

Adult Health Checks can be provided 2 different ways

Population health screen

  • Has a smaller number of checks to find significant health problems. This allows maximum community coverage (more people get screened)
  • Can be undertaken (done) by
    • Screening checks at health weeks 
    • Screening people when they come to the clinic (opportunistic screening)
    • Screening teenagers or older people (certain age group) or people with certain conditions (targeted screening)

Population health screen plus individual assessment 

  • Has a larger number of checks and takes more time to do  
  • Can be claimed as Medicare Health Assessment
    • All Aboriginal or Torres Strait Islander persons — Item 715
    • Non-Aboriginal adults who meet set criteria — Item 701, 703, 705, 707

Risk factors and problems assessed

  • Lifestyle risk factors and issues for older people including access to meals
  • Chronic conditions, cardiovascular risk, STIs
  • Cancers — cervical, breast, bowel
  • Common conditions often missed in normal health care delivery 
  • Social and emotional wellbeing — any stressful events, drug and alcohol issues, worries, violence, safety concerns

Do First

  • Always check if person has a known chronic condition — are they aware of it
    • If person has a known chronic condition do the items in the usual management plan — these will cover the chronic conditions part of Adult Health Check
  • Check if there are care plans for Adult Health Check on your clinic patient information system

Adult Health Check checklist — population health screening component

Lifestyle risk factors (SNAPE)

S moking and/or chewing tobacco — ask how much, how long, want to stop, tried to stop — how many times. Quitting smoking is the most important lifestyle change

N utrition — ask about fruit and vegetables, takeaways, sugary/soft drinks and food security. Give information on healthy diet

A lcohol — work out how much alcohol person drinks, provide information on safe drinking and cutting down. Ask about other drugs — cannabis (gunja), inhalants/sniffing, kava

  • Ask about sleep disturbances —  regular use of alcohol and/or other drugs can interfere with normal sleep patterns 

P hysical activity — ask how much physical activity/exercise they get, give advice on recommended levels of physical activity

E motional and social wellbeing — ask how they are feeling, how they are coping with everyday activities, loss and grief issues

See Tobacco, Healthy lifestyle choices, Brief interventions

Aim to screen everyone who is eligible with this checklist

* As part of the National Bowel Cancer Screening Program 

Adult Health Check checklist — individual assessment component

Extra assessment items if resources/capacity, or plan to claim Medicare item  

 †† Osteoporosis risk factors

Bones — fracture with minimal trauma or poor bone density on x-ray indicate likely osteoporosis

  • Long-term use of glucocorticoid therapy (eg prednisolone)
  • Early menopause (before 45 years) OR amenorrhoea (prolonged times with no periods), may occur with eating disorders or malnutrition

Patient Health Questionnaire 2 (PHQ2)

‡ Patient Health Questionnaire 2 (PHQ2)

©PHQ2 adapted for use with Aboriginal people by Professor Alex Brown, South Australian Health and Medical Research Institute. Used with permission.

Interpreting scores

Follow-up

  • Arrange time to talk about results, treatment and management
  • Arrange repeat testing for abnormal results after medical consult, usually within 3 months

Population screen

  • Review pathology results
    • If positive STI offer treatment, contact tracing 
    • If reduced eGFR OR increased ACR — see Chronic kidney disease
  • Medical consult if
    • Abnormal pathology results
    • Absolute cardiovascular risk more than 15%

Individual assessment

  • Medical consult 
    • Any abnormal findings
    • One or more osteoporosis risk factors
  • Dental consult if oral or dental problems
  • Refer to other agencies as needed
  • Write in notes — patient centred goals, recalls, appointments