Catherine J Wheeler MD, Angela Deneris CNM, PhD, Elicia Williams-King MD, Shanna M Salmon BS
University of Utah, Salt Lake...
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Published on: Mar 3, 2016

Transcripts - NAMS 1

  • 1. Catherine J Wheeler MD, Angela Deneris CNM, PhD, Elicia Williams-King MD, Shanna M Salmon BS University of Utah, Salt Lake City, UT, USA BACKGROUND RESULTS RESULTS AIMS • As women age they tend to experience chronic health problems • Many chronic health conditions respond to changes in lifestyle, such as physical activity, improved nutrition, weight loss, and smoking cessation • In response, in 2007 the University of Utah initiated a multidisciplinary, comprehensive women’s midlife assessment clinic CONCLUSIONS METHODS RESULTS 2 4 6 8 10 12 14 16 18 20 22 within 1 year1-2 years 2-3 years 3-4 years > 4 years never GYN Pap Mammogram Primary Care Lipids Dermatology Interval Since Last Preventive Care, Among Those With New Health Condition 38% 35% 15% 10% 2% Within 1 year Between 1-2 years Between 2-3 years Between 3-4 years Greater than 4 years • A new health condition was identified in 25 of 34 participants (74%) – excluding dermatology • 73% of women with a new diagnosis had a health care visit within the last 2 years • Women 40-65 years of age, with a mean age of 58, attended 4 pilot clinics • Previously undiagnosed health conditions identified included: melanoma, cardiomegaly, breast mass, hypertension, abnormal lipids, pre-diabetes, osteopenia, abnormal TSH, cervical polyp, vitamin D insufficiency and deficiency, and eczema • Only one participant did not have risk factors for heart disease Capturing Undiagnosed Health Problems in a Multidisciplinary Comprehensive Women’s Midlife Assessment Clinic: A Pilot Study Number of women • To comprehensively evaluate the health risks, symptoms, and behaviors in women who attended the Women’s Midlife Assessment Pilot clinics • To identify trends of existing and newly diagnosed conditions • 34 women, ages 40-65, attended 4 pilot clinics • Participants completed a comprehensive health questionnaire and performed appropriate testing prior to the clinic date • Evidence-based labs, mammogram, and bone density were completed and reviewed in advance • Clinic participants were evaluated by: Primary Care, Gynecology, Dermatology, and Audiology, and consulted with a wellness coach • To identify trends, all questionnaires, assessment notes, and results were reviewed to identify the frequency of symptoms, conditions, and diagnoses Last Preventive Care • 26 of 34 women (76%) had been seen by their provider within the last 2 years 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 * Heart disease risk factors exclude BMI and waist circumferance Pre-existing Identified at clinic Pre-existing and identified at clinic Family history of heart disease Heart Disease Risk Factors * Depression Diagnosis with treatment (7) Diagnosis without treatment (6) New diagnosis in clinic (7) Total with symptoms (20) 2 6 10 14 18 22 26 30 34 Number of women with depression symptoms Number of women 2 4 6 8 10 12 14 16 18 20 22 Treatment in clinic Referred for skin lesions Treatment in clinic and referred • Conditions treated in clinic included: - Actinic Keratosis - Seborrheic keratosis -Acrocordia Dermatology Number of women • 59%had never obtained a Dermatology evaluation • Data from last 2 pilot clinics only • A significant number of chronic medical problems and skin lesions are being missed in routine preventive exams • Heart disease risk factors are nearly universal. This clinic offers an opportunity for education and intervention to decrease heart disease risk • In this cohort, depression was common and 62% of women with depression untreated or undertreated • This health care model with same day access to multidisciplinary care improves identification of health conditions • Access to comprehensive health history and testing results prior to seeing patients results in improved diagnostic ability • Working with a multidisciplinary team also improves diagnostic ability • This cohort was highly educated, insured, and seeking care. In populations with less access to medical care, there is a potentially higher impact in identification of disease

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