Re-designing the annual wellness visit

Background: Recent changes with the Affordable Care Act defined essential preventive health measures.  Based on scientific evidence, screening intervals for certain cancers can be extended.  Both of these changes have contributed to the discussion regarding the lack of evidence for the annual pelvic exam in low risk, asymptomatic women.  This presentation presents options for re-designing the annual gynecological exam to a wellness visit better suited to meeting national health care benchmarks.

Purpose: The annual gynecological exam has focused on screening, evaluation, counseling, immunization review and healthy lifestyle recommendations.  To expand this visit to an even greater focus on wellness, a public health framework of primary prevention is utilized to re-design this visit.

Methods: To implement primary prevention, the Centers for Disease Control model of reproductive life planning (RLP) provides specific tools for patient use with attention to pregnancy prevention or preconception care.   The tools of RLP are built on the concepts of health coaching and motivational interviewing, which when used incorporated into care, have the potential to improve contraceptive use, preconception health and health care decision-making.   For postmenopausal women, the focus of the wellness visit expands to include a renewed or continued focus on sexual wellness, breast health, screening for intimate partner violence and overall health and wellness.  The prevention of heart disease and stroke using the modifiable risks factors identified by the million health initiative are stressed.

Case studies of service delivery models from countries where annual gynecological visits and routine pelvic exam are not the norm will be presented. These models suggest outcomes for women’s health at least equal to those in the U.S.

Conclusion: A redesign of the annual gynecological exam to that of an expanded prevention-oriented wellness visit, occurring either in a women’s health or primary care setting, offers the potential to meet Healthy People Goals.