Adults

General Recommendations 

AAFP Preventive Healthcare Schedule, see p3-4 for the recommended adult preventive services from USPSTF

Search USPSTF Recommendations

Advanced Care Planning: Ohio DNR Form, values worksheet (give patient a whole packet)

Vaccine Schedule: Adults - CDC

ASVCD Risk Reduction

Cholesterol Management, based on 2018 ACC recs (chart on p 12) .lipidmanagement has all the charts in it

ASCVD Risk Calculator, ACA/AHA pooled cohort calculator (also .ASCVD but make sure DM dx and smoking hx are updated).

Aspirin for primary prevention: 

2019 ACC/AHA recs Consider for 40-70 y/o with high risk of ASCVD and no increased bleeding risk
USPSTF recommendation is under review (previously: use low dose for 50-59 y/o if 10y risk>10%)   

Omega-3 fatty acids: discordant results from recent large RCCs

2020 Cochrane Review no clear benefit, may slightly reduce coronary outcomes but not overall ASCVD outcomes
2021 Lancet Review EPA alone has benefit but DHA + EPA does not

Unrecognized MI Criteria 

Cancer Screening (see below)

Specific Populations (see below for Elderly and Adults with Disabilities) 

Childhood Cancer Survivors 

Screening Guidelines from Children's Oncology Group

Adults with Down Syndrome

2020 guidelines: Screening Checklist, full guideline, recommendations table on page 16 from Global Down Syndrome Foundation
Down Syndrome Medical Interest Group, Resource Library from Advocate's Adult Down Syndrome Center for patients, caregivers, and health professionals
Early Detection Screen for Dementia

Sickle Cell

2019-2021 ASH Clinical Guidelines for SCD (can also download the ASH Practice Guidelines app, which has lots of other info as well!)

Special Indications Based on Personal History/Factors

HIV: Increased risk of cervical, liver cancer

Cervical Cancer Screening, per ACOG, assuming normal results:

<21 y/o: start screening when sexual activity begins
<30 y/o: new cytology at HIV diagnosis, then annual screening, then can do q3y cytology
>30 y/o: new testing at dx then: either co-testing q3y or 3 annual cytology tests followed by cytology q3y
lower threshold for colposcopy in general 

Hepatocellular Cancer: controversial rec for ultrasound screening if Hep B or Hep C is positive

Immunosuppression: solid organ transplant, IBD, RA with immune modulators

Cervical Cancer: annual pap and HPV testing

Trisomy 21 (Down Syndrome): Increased Risk of Leukemia, gonadal cancers

Leukemia: annual CBC

Gonadal/pelvic cancers: annual testicular exam, Pap smear and pelvic exam (every 1-3 yrs. after first intercourse). If not sexually active, singlefinger bimanual exam with finger-directed cytology exam. If unable to perform, screen pelvic ultrasound (every 2-3 years). Breast exam (annually). 

Breast Cancer - annual breast exam (less likely do notice a lump themselves?)

Cirrhosis: screen for HCC q6m with ultrasound +/- AFP

Chest Radiation

Recommendation from the American Cancer Society 

IF radiation to the chest between 10 and 30 years old

THEN screen for breast cancer with MRI and mammogram annually starting at age 30

BRCA

Rec from the American Cancer Society: Screen for breast cancer with MRI and mammogram annually starting at age 30
Rec from ACOG
Breast Cancer 25-29: MRI annually, 30+ MRI and mammogram annually
Ovarian Cancer: Consider CA-125 and/or Ovarian ultrasound starting at age 30-330-35
NCCN Recs  if +fam hx of  pancreatic cancer, consider EUS or MRCP starting at the earlier of 50 y/o or 10y before earliest dx

Lynch Syndrome (hereditary non-polyposis colon cancer, HNPCC)

Consider Lynch if 3+ family members with cancers in 2+ generations AND at least 1 pair are 1st degree relatives AND 1+ <50y at dx AND FAP is excluded
American College of Gastroenterology Recommendation
Screening colonoscopy starting at 20-25y, at least q2y, prefer annually if confirmed carrier
Consider EGD once for gastric, duodenal cancer at 30-35, consider 3-5y repeat
Endometrial bx and transvaginal ovarian ultrasound annually if no surgery

Familial Adenomatous Polyposis (FAP), also MAP and AFAP

American College of Gastroenterology Recommendation
Annual colonoscopy starting at puberty

Pending...

MEN2A

MEN2B

MEN1

NF1

Chest Pain

Pretest probability model for CAD: CAD Consortium

ACC algorithm for stable chest pain: no known CAD, known CAD

Diabetes

DM Medical Management Diagrams, from ADA 2020 standards of Care
full document here, abridged for PCPs here
for medication info for discharge instructions, try .diabetesmedsinstructions
Diabetes Education Videos from Penn Medicine

Headaches

Formal Classification System
Red Flags: new headaches >50 y/o, positional, new type, brainstem aura, unexplained weight loss, immunocompromised, focal neuro exam
Migraines make up  75-90% of headaches presenting to primary care
Try the primary care treatment app for med help diagnosis and 4 short good learning modules

Acupuncture often covered for migraines (see Chronic Pain below)

HTN

for medication info for discharge instructions, try .hypertensionmedsinstructions
Simplified Management Protocol - AMA

Infections

ABx Coverage Chart

Iron Deficiency Anemia

1. Create Infusion Treatment Plan --> OP IRON REPLACEMENT INFUSION PLAN

Will ask for an attending physician at some point.

2. Aa. Pre-Cert Authorization

        UCH Non-Chemo Authorization Urgency Attestation

Category: Aa. Pre-Cert Authorization

Ref to Department: UH INFUSION SVCS GNI

Comments: Include as much information as possible about the need for iron infusions. 

3. MD Communication II

Has the patient fialed other IV iron regimens?: Asking about the use of Venofer if attempting to order Monoferric (the one-time, 1g version rather than 300mg x3 weeks)

Has the patient failed oral iron therapies?: Either treatment failure or side effects of oral iron (constipation, GI upset, etc.)

Comments: If selecting an IV iron plan that is NOT the one that was initially selected, indicate what you'd like them to do if it is not approved (ie: If unable to obtain prior authorization for MONOFERRIC, please switch to VENOFER 300mg weekly.)

4. Medications

Calculate iron deficit using Ganzoni equation (MDCalc)

Select between iron regimens (usually Venofer 300mg weekly, but if <1g deficit can try for Monoferric 1x dose)

Lung Disease

Inhaler Chart, inhalers4u.org
Asthma Severity Criteria, Asthma Treatment Steps (GINA & NIH charts), Inhaler Intensity Chart
GOLD app, COPD Tx Recs from the American Thoracic Society
CAT (COPD Assessment Test) >10 => choose LAMA/LABA combo for treatment even if no exacerbation

Musculoskeletal Pain

.backpainvideos

University of Michigan videos targeted based on a set of questions

Stretches for acute relief of sciatica from herniated disc from Spine Universe

AAOS Targeted Exercise Programs PDFs: Spine, Shoulder, Knee

Rheumatology Criteria - American College of Rheumatology, includes various diseases includes some kids stuff, click "excerpt" link if available

Sleep Concerns

CBT for Insomnia - evidence based tx for insomnia - CBTI Coach is an app intended as an adjunct but may help if CBTI is not accessible

Sleep Apnea - try home sleep study for pts with fewer comorbidities, type home sleep and go to database
Epworth Sleep Scale, Stop Bang

Need for Dietician -  type CPC into orders (comprehensive primary care)

Assessment Tools

PHQ-9 GAD-7 Both (put responses in flowsheet, for ease add the screening tab)
Geriatric Depression Scale simpler than PHQ-9, validated tool for elderly patients, normal is <5
MDQ Bipolar screener to detect mania/hypomania, positive if 7 or more yeses in question 1 and question 2 is yes and question 3 is moderate to severe
PCL-5 PTSD eval developed by the VA (additional info), updated for DSM 5 (scale changed so scores not comparable to previous version), not re-validated, cutoff score for benefit from treatment is a total ~32, clinically significant improvement is a decrease of 10 or more

Smoking Cessation

Ohio Quit Line, free coaching by phone & text, 8 weeks free NRT
Kentucky Quit Line, free coaching by phone & text, may have to pay for NRT
Quit Plan smokefree.gov

Therapy Resources  (try .therapistresources)

Short Term Therapy for Depression through our depression manager here in clinic (must have documented PHQ-9>10)
Finding a counselor
lifestance.org  (formerly psychbc), for Cincinnati 844-468-5050, also has psychiatrists, in person and telehealth available
Psychology Today
thecounselingsource.com, tele-therapy available for patients on Medicaid
Also, the places under dual diagnosis have mental health services

Medications

NAMI has great info pages on specific medications.

Emergencies and Urgent Needs

988 national mental health crisis / suicide hotline   !NEW!

Psychiatric Emergency Services (PES) when there is an immediate risk of harm to self or others
(513) 584-8577

Mobile Crisis Team for mental health crises in the community
(513) 584-5098, after hours call PES above

Crisis Stabilization Center at MHAP - an alternative to in patient hospitalization (for non-emergencies), partial hospitalization available
Mental Health Access Point, part of Central Clinic
(513) 558-8888

Talbert House has same day outpatient services for addiction and mental health

Addiction medicine allows week day walk-ins from 8-9am

Dual Diagnosis

GCB Greater Cincinnati Behavioral Health, good care management, dual diagnosis as well as substance use or mental health concerns alone, housing and criminal justice services, adolescent mental health transition services, employment services contact info by location

Talbert House has a wide variety of services including: same day outpatient services for addiction and mental health, MAT, services for survivors of abuse, youth employment, halfway houses
513-221-HELP (4357)
24/7 Crisis Line: 513-281-CARE (2273) or text: TALBERT to 839863 

Center for Addiction Treatment offers medically supervised detox, residential, residential substance use treatment, outpatient treatment, MAT, support groups for family members
Access Team: (513) 381-6672

Additional Community Resources

One page phone # list for multiple resources

UC Stress Center
specialized individualized treatment program for PTSD, order a psych referral, choose the PTSD/stress option
513-558-5872

NAMI SW Ohio (National Association of Mental Illness)

Treatment Locator from Substance Abuse and Mental Health Services Administration, a division of HHS
24/7 National Referral Helpline: 1-800-662-HELP (4357) English and Spanish
24/7 National Suicide Prevention Lifeline 1-800-273-TALK (8255) 

Harm Reduction for Active Substance Use
Hamilton County Public Health Department Programs
FREE Narcan (can be through the mail)
Syringe Program Rotating sites

If you counsel any of your patients about firearm safety during any visit, you can now use the dot phrase .FIREARMSAFETYCOUNSELING in your A&P!

Curable an online pain psychology program/app, $5/month

UC Chronic Pain Guidelines, (Sign into UC mail first) Naloxone requirements, Med Peds Clinic: Opioids 

Type "integrative" into the orders search bar, all but massage should be covered by insurance (acupuncture is usually covered for LBP and migraines)

UC Integrative Medicine 

Personal Health Inventory

National Center for Integrative Care

VA Whole Health

Academic Consortium of Integrative Medicine and Health

IM4US, integrative medicine for the underserved

Integrative Medicine Textbook, Rakel

Dr. Wayne Jones:

How Healing Works books

HOPE note and process

www.nhs.uk/medicines/ good general reference for patients with simple clear info, some name differences exist, e.g. acetaminophen is paracetamol there

Pill identifier at drugs.com based on the imprint

AFFORDABILITY/ACCESS

Do a medication access referral through Hoxoworth pharmacy for our patients
Ohio Medicaid Drug List All Ohio Medicaid managed care plans use the same preferred drug list
Ohio Medicaid Drug Coverage Lookup Tool May need to use the brand name
St. Vincent dePaul Charitable Pharmacy  Referral Form "last resort" pharmacy for people who cannot afford meds, meds mostly donated so limited and variable formulary, must certify to qualify
GoodRx - legit discounts when insurance won't cover meds

SPECIFIC PATIENT NEEDS / Medical Issues

crediblemeds.org - info on QT prolonging meds
LactMed database on medications and lactation
LiverTox database on meds and supplements that cause liver injury
NIH Supplements complementary medicine treatments and supplments safety page
mothertobaby.org - website for medication safety during pregnancy, YOU CAN MESSAGE AN EXPERT!
Excellent fact sheets about specific meds, foods, medical conditions, drugs, cosmetics, etc. They also have ongoing studies.
Beer's List
Gluten Free Med List not updated often, but very there is no required reporting for this, from glutenfreedrugs.com run by a peds GI pharmacist

Toxicology

Micromedex: good resource for toxic effects of meds (DPIC uses it)
Children's Centerlink > Residents > Patient Care links > Clinical Resources > Micromedex
within it look up substance/med, then in the left panel there is a toxicology section
choose in-depth answers tab on top if available for that med
within the treatment section there may be a disposition bullet point to tell you observation time  

DPIC will do pill ID if they have the specific pill.

Safe Medication Disposal

Take Back Locations -  includes many pharmacies including hoxworth and the main UC lobby
General Disposal Guidelines
FDA flush list - benefit of getting rid of med considered higher than harm from flushing

STIs, Treatment and Prevention, Sexual Safety in general

CDC's STI Treatment Guidelines 2021 changed for chlamydia, trichomonas, PID
Expedited Partner Therapy Guidelines, EPT Law in Ohio

Screen more than genitals, MSM STD Fact Sheet, MSM Shigella
Free Condoms Ohio only, lube + 25 condoms or dental dams mailed if 16+ y/o, can do every 30 days, no income restrictions, DOTPHRASE .freecondomsohio
Condom Do's and Dont's Spanish version
Try .douching .poppers for patient information on these topics

PrEP

PrEPline National Clinician consultation Center – 855-448-7737 open 9a-8p EST

1 Pager on how to do PrEP
National Ready Set Prep Program, free coverage for prep meds if no insurance coverage
Preventon Assistance Program Interventions (PAPI) Ohio Program to cover all PREP related care for certain incomes
Dot Phrases [can be found under .MPDOTPHRASES]:

.PREPDISCUSS [when discussing at visit]

.HMPREPDISCUSSED [to fulfill Care Gap]

.PREPSTART [when starting PrEP, either during visit or on phone visit if starting after]

.ORALPREPMONITOR [for monitoring guidelines for Truvada, Descvoy]

.CABOTEGRAVIRMONITOR [for monitoring guidelines for Apretude]

Contraception

Effectiveness, Use, and Side Effects Chart from CDC less pretty, but more info, side effects counseling is important!!
Contraception Effectiveness from bedsider.org
Emergency Contraception Chart from bedsider.org
CDC's Missed Contraception Recommendations
CDC Medical Eligibility for Contraceptive what contraception can and can't be used with what medical conditions

Abortion

Resources:

abortionfinder.org
Abortion pills by mail: Information from Plan C read for details on legality and safety
Help with funding:  National Network of Abortion Funds, www.chicagoabortionfund.org, Ohio organization: Women Have Options
Help with transportation, lodging, childcare: brigidalliance.org, www.midwestaccesscoalition.org
In Cincinnati (counseling and abortions): Planned Parenthood - Cincinnati Surgical Center 2314 Auburn Avenue · Cincinnati OH, 45219 · Contact Phone: (513) 287-6488 (website not updated yet)

Need 2 separate appointments >24 hours apart (appointment with UC OBGYN will NOT count as one)

1st appointment: $200 (can get some financial assistance, but typically need at least $100 up front)

2nd appointment: $500 if 5w-13w6d with sliding scale payment plan

Now as of 10/7/2022 an injunction is in place to negate the new Ohio law. Legal up to 21w6d in Ohio. But if it goes back in to effect, the following will be law again:

Ohio Law:
Now illegal in Ohio for intrauterine pregnancies if a heartbeat is detected and provider has to look for one (externally), ~6 weeks.
Exceptions: "to prevent the death of the pregnant woman or to avoid a serious risk of the substantial and irreversible impairment of a major bodily function of the pregnant woman"
Explicit exceptions include: pre-eclampsia, inevitable abortion, and premature ROM, extrauterine pregnancies
No exception for rape or incest
No exception for mental health related problems including suicidality
Doctors providing abortions are subject to felony charges, potential loss of license and potential fine of up to $20,000 per case.
Women seeking abortion are not subject to criminal or civil liability.

Indiana Law
Goes into effect 9/15/22. Abortion outlawed at any stage. Exceptions: rape or incest, fatal fetal abnormality, risk of death or severe health risk to the pregnant person

Kentucky Law:
Abortion illegal at every age. The only exception is if the pregnancy threatens the life of the mother.

Transgender/Gender Diverse Patients

Affirming Hormone Therapy

Hoxworth Protocol 1-Pager
Guidelines: WPATH 8th Edition 2022 widely cited global guideline, Endocrine Society 2017 has a few good quiz MCQs in the slidedeck, UCSF 2016 includes good guidelines on VTE

Additional Gender Resources

Equitas Provider List gender affirming providers of various types, therapists, dentists, community groups
Gender Unicorn (additional languages)
Trans Legal Rights Ohio name change ID etc, LGBT Legal Clinic (free for certain incomes)  855-LGBT-LAW
Trans Lifeline excellent resource for emotional and practical support, for trans by trans including a hotline
Try .binders for patient information on this topic

Mental Health

Trans Lifeline a by trans, for trans hotline for emotional and practical support (877) 565-8860
The Trevor Project 24/7 free confidential crisis counseling by text, chat or phone for young LGBT people
Central Clinic's LGBTQ+ Program for adult Medicaid patients or Hamilton county uninsured patients

National LGBTQIA+ Health Education Center (from Fenway Health)
LGBT Resource Lookup Tool
Parenting Resources click LGTBQIA+ Parents
College Guide for LGBT Students

Mini-Mental State Exam (doesn't test executive functioning)
MoCA (does test executive functioning)
Mini-Cog fast!

Advanced Care Planning: Ohio DNR Form, values worksheet

Geriatric Depression Scale Y/N, simpler than PHQ-9, validated tool, normal is <5

Beer's List

Anticholinergic Burden Reference, ACB Score calculator
Each definite anticholinergic may increase the risk of cognitive impairment by 46% over 6 years.
For each on point increase in the ACB total score:
a decline in MMSE score of 0.33 points over 2 years has been suggested.
has been correlated with a 26% increase in the risk of death. 

Council on Aging SW Ohio (513) 721-1025
Help to stay independent at home, in home care, meals, caregiver support

Senior's Guide to Online Safety from Connect Safely silicon valley non-profit

Elder Abuse Suspicion Index, any yes except the first question is a positive screen

Adult Protective Services Ohio, Kentucky (call during business hours)

Screening

See above in "Routine Health Maintenance"

Medical Management

Medical Complexity One-Pagers: Enteral feeding tubes, trachs, airway clearance, shunts, baclofen pumps, and autonomic dysfunction

Cerebral Palsy for the PCP (screening & management)

Guardianship

See Social Work Info above

Transportation

Disability Placard Guide: Letter is called "Gen to Third Party Disability Parking Prescription"

Metro Fare Deal Program: Discounts fare for those who are elderly, have disabilities, use Medicare, must apply in person during limited hours

Metro Access Program: Origin to destination service for those unable to ride the bus, complex application and in person assessment process

Community Resources

Stepping Stones: Child, teen, and adult day programs, respite care, summer programs, clubs, private pay only

The TALL Institute: Classes and community groups for adults with disabilities, including life skills (cooking, money management), relationships, fishing, and more

Hamilton County Developmental Disabilities Services: Connects children and adults with services, coordinates early intervention

Therapy

Physical Therapy: Refer to Lauren Niehaus and put "patient with IDD" or "transition" in the referral comments so that it will go to someone with experience if Lauren is full

Communication Card for Police

General Information

Ohio Solid Organ Transplantation Consortium (OSOTC): Explore OSOTC resources to understand the review process, selection criteria, and policies as they relate to organ transplants at member hospitals.

People with Disabilities

Autism Self-Advocacy Network (ASAN): Toolkit for Advocates on Ending Discrimination

• The “Know Your Rights” guide provides people with disabilities and their families with information on existing laws and policies that may protect them from discrimination, and information on who to contact if they experience discrimination.

• The Guide for Advocates provides information on ways that advocates can help fight organ transplantation discrimination on a wider basis, such as through legislative advocacy and outreach to the medical community.

• The Model Legislation on organ transplant discrimination provides an example of effective anti-discrimination legislation that advocates can propose to their state legislatures.

• The Guide for Clinicians and Checklist of available supports and services gives doctors and other health professionals concrete advice on how to serve people with disabilities who may need an organ transplant.