Prevention/Care Management, 2008
Department of Defense
The U.S. Department of Defense (DoD) has changed its policy of providing routine physical examinations for active duty and reserve military personnel every five years. Instead, it now directs military health providers to perform a periodic health assessment (PHA), based on U.S. Preventive Services Task Force recommendations.
The PHA is a preventive screening tool designed to improve reporting and visibility of Individual Medical Readiness for all active duty troops, as well as to provide an opportunity for health risk assessment and provision of clinical preventive services and other health needs. The Air Force first implemented the PHA in 1997, and has provided assistance to other branches of the military since the DoD ordered the PHA to be phased in for all branches of the military in November 2006.
"Since we switched from the five-year physical exam in 1997, we have been using the U.S. Preventive Services Task Force recommendations as our core guidelines," says Colonel Michael Snedecor, MD, MPH, Air Force Chief of the Public Health Division and Preventive Medicine Consultant.
According to Lynn Pahland in the Office of the Assistant Secretary of Defense, the change in policy was written with the input of all military service specialists in their specific policy areas and is patterned after national best practices. "The DoD has been using the clinical and medical expertise within the Department of Health and Human Services as one very important source of information for the development of policy in many areas," she says.
The PHA policy mandates an annual face-to-face assessment for all active duty and reserve component personnel, which encompasses clinical preventive screening tests, immunizations, surveillance of occupational risks, medical record review, assessment of deployment readiness, and counseling that targets the individual's risk factors and behaviors.
The annual assessment of a service member's health status provides an opportunity to review and validate individual medical readiness and correct any deficiencies. As a resource to the medical staff performing the assessments, military PHA policy documents provide links to the Task Force recommendations. The recommendations themselves will be programmed into patient records as reminders.
The following components are included in the PHA, based on Task Force recommendations and service requirements:
- Height, weight, and body mass index calculation.
- Blood pressure measurement.
- Visual acuity assessment.
- Documentation of any individual medical equipment required.
- Hearing assessment (for the Air Force, only if required by occupational exposure).
- Immunization updates.
- Tuberculosis screening.
- Laboratory studies, including lipid screening.
- Dental examination.
- Deployment-limiting medical conditions.
- Worker certification examinations.
- Cardiovascular risk screening.
- Female-specific screenings, as appropriate.
- Colorectal cancer screening.
- Health risk assessment and counseling, using a comprehensive DoD-developed health risk assessment tool.
- Physical fitness assessment clearance.
Captain Patricia Dorn, Nurse Corps, Population Health Program Manager for the Navy, says, "The PHA is a great opportunity for health providers to assess individuals and take time to counsel them on their health needs. We recommend that service members take advantage of the annual assessment. They should go to the appointment prepared to learn more about their health and any lifestyle changes they can make to improve their health and well-being."
Colonel David Peterson, Chief of Army Public Health Nursing, Tripler Army Medical Center, notes, "Having the face-to-face encounter annually has the potential to pick up health problems early, before they become chronic problems that may result in a non-deployable status. And having common denominators as a standard of practice helps providers and soldiers with a common reference tool and consistent teaching, no matter where the soldier accesses the military medical system."
Using the Task Force recommendations as a basis for the PHA "provides medical personnel a resource to help focus their health assessments and offer evidence-based medical advice and education that should be the standard for medical personnel during their time with a soldier," Peterson says.
Air Force Col. Snedecor notes, "DoD actively participates as a U.S. Preventive Services Task Force partner, providing liaisons who attend the Task Force meetings, contribute input to the Task Force, and provide feedback as users of its recommendation." Snedecor serves as the Military Health System liaison to the Task Force.
"We also rotate all our Preventive Medicine residents from the Uniformed Services University of Health Sciences through AHRQ, where they often contribute to the preparatory research for Task Force recommendations," adds Snedecor.
The military PHA requirement covers nearly 2.2 million troops in total. Approximately 340,000 active duty Navy, 177,000 active duty Marine, 70,000 Selected Reserve Navy, and 40,500 Selected Reserve Marine personnel are included. In the Air Force, about 340,000 active duty and 76,000 Reserve Air Force personnel, plus about 105,000 Air National Guard troops are covered. The Army PHA includes approximately 500,000 active duty and 538,000 Selected Reserve troops.
The U.S. Preventive Services Task Force recommendations are available at http://www.ahrq.gov/clinic/prevenix.htm.
Impact Case Study Identifier: CP3 08-01
AHRQ-Sponsored Activity: U.S. Preventive Services Task Force (USPSTF)
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