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

POPULATION HEALTH SCREENING	Aboriginal adult 18–54 years	Aboriginal adult 55+ years	Non- Aboriginal adult 45–74 years	Non- Aboriginal adult 75+ years
Ask
Lifestyle risk factors see SNAPE above check file notes — don't do if done recently	✓	✓	✓	✓
Sexual health — see STI men and STI women	✓	✓	✓	✓
Check
BP	✓	✓	✓	✓
U/A (protein)	✓	✓	✓	✓
Immunisation status	✓	✓	✓	✓
Do
FBC, UEC, eGFR, HbA1c, BGL (random/ fasting), lipids (random/fasting)	✓	✓	✓	✓
Urine ACR — see Chronic kidney disease	✓ 30+ years Under 30 years — if protein 1+ or more	✓	✓ If protein 1+ or more	✓ If protein 1+ or more
Check notes for Hepatitis B status, if unknown do screen	✓	✓
Cardiovascular risk assessment — except if already known to be high	✓	✓	✓	✓
Breast screening — every 2 years	From 50 years (start at 40 if relative with breast cancer)	✓ Stop at 74 years	✓ 50–74 years
Full STI check — see STI men and STI women	✓ Under 35 years
Cervical screening if due	✓	✓ Stop at 74 years	✓ Stop at 74 years
Bowel screening — every 2 years*	✓ From 50 years	✓ Stop at 74 years	✓ 50+ years
Brief interventions regarding healthy life style and safety	✓	✓	✓	✓
Pre-pregnancy counselling	✓

* 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

INDIVIDUAL ASSESSMENT Complete to claim Medicare health assessment	Aboriginal adult 18–54 years	Aboriginal adult 55⁺ years	Non-Aboriginal adult 45–74 years	Non-Aboriginal adult 75⁺ years
Ask
General health	✔	✔	✔	✔
Family health history	✔	✔	✔	✔
Social situation including gambling/financial problems	✔	✔	✔	✔
Medications — understanding of, taking correctly	✓	✓	✓	✓
Sleep — how much, when (day/night), snoring	✓	✓	✓	✓
Vision — glasses, contact lenses	✔	✔	✔	✔
Hearing — hearing aids	✔	✔	✔	✔
Dental and oral problems — pain	✔	✔	✔	✔
Menopause problems	✓ 45⁺ years	✔	✔
Contraception	✔
Urinary incontinence	✓	✓	✓	✓
Erectile dysfunction	✔	✔	✔	✔
Osteoporosis risk factors ††	✓ 50⁺ years	✔	✔	✔
Physical function, falls, home accidents Social supports, nutrition Memory, dementia		✔ If frail		✔
Check
Pulse	✔	✔	✔	✔
BMI, waist circumference	✔	✔	✔	✔
Vision	✔	✔	✔	✔
Trichiasis		✔	✔
Ears — wax, perforations		✔		✔
Hearing — tuning forks	✔	✔	✔	✔
Mouth, throat, teeth and gums	✔	✔	✔	✔
Skin exam — look for scabies, sores, tinea, acanthosis nigricans	✔	✔	✔	✔
Breast exam	✓ 50⁺ years	✔	✓ 50⁺ years
Do
Medical Consult	✔	✔	✔	✔
PHQ2‡	✔	✔	✔	✔

†† 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)

Over the past 2 weeks how often have you been feeling the following?	None (Score 0)	A little bit (Score 1)	Most of the time (Score 2)	All of the time (Score 3)
Have you been feeling slack, not wanting to do anything
Have you been feeling unhappy, depressed, really no good, that your spirit was bad
Total score (0–6)

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

Interpreting scores

0–2 — likely to be well
3 or more — complete Patient Health Questionnaire 9 (PHQ9)

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