Clinical Preventive Services & Health Promotion

Domain 1: Foundations of Clinical Health Promotion and Disease Prevention Domain 2: Primary Prevention Domain 3: Secondary Prevention Domain 4: Tertiary Prevention Domain 5: Mental Health, Behavioral Health, and Well-being

Domain 1: Foundations of Clinical Health Promotion and Disease Prevention

A. Effective health professional‐patient communication

1. Dynamics of the health professional-patient relationship

2. Patient-centered communication aligned with health literacy levels

3. Patient education

4. Shared decision-making, patient autonomy, and self-determination

5. Communication with individual patients and groups

6. Multi-method approach addressing diverse needs

7. Trauma-informed communication strategies

B. Applied health promotion in clinical settings

1. Culturally and linguistically appropriate patient education materials

2. Effective behavioral modification programs

3. Effects of patient mistreatment and inequitable health resources on clinical interactions and health outcomes

4. Social and economic root causes of barriers to care and their impact on health

C. Evidence-based health care, decision-making, and recommendations

1. Evidence-based guidelines and recommendations from international, federal and profession-specific organizations and regulatory bodies to address prevention at the individual, community, and population-levels

a. U.S. Preventive Services Task Force

b. The Guide to Community Preventive Services (The Community Guide)

2. Role of continuing education, continuous learning, and professional development to appropriately select, evaluate, and utilize resources

D. Technology for health promotion and disease prevention

1. Telehealth, telemedicine, and telecare

2. Mobile health (mHealth) applications

3. Remote patient monitoring

4. Health information exchange platforms

5. Synchronous and asynchronous telehealth modalities

6. Benefits, risks, and limitations of artificial intelligence

7. Decision-making influenced by machine-learning algorithms and precision medicine

8. Patient technology literacy and digital health information access

9. Accessibility and usability standards

Domain 2: Primary Prevention

A. Lifestyle-associated behavior counseling, education, and referral

1. Nutritional health

a. Diet, weight management, supplements

2. Physical health

a. Physical activity, daily life activities, sleep impairment, stress, disability

3. Oral health

a. Oral hygiene and access to dental care

4. Substance use

a. Behavioral, environmental, social drivers

5. Tobacco, vaping, alcohol, and prescription drug misuse

a. Cessation strategies for harm reduction

6. Sexual health

a. Education, STI prevention, reproductive counseling

7. Mental and emotional health

a. Stress management, coping skills, access to mental health care

B. Sustaining preventive interventions

1. Individualized needs and biologic determinants

2. Interprofessional team coordination and collaboration

3. Preventive interventions based on individual, community, and population needs

4. Financial and human resources necessity and availability

5. Long-term health needs of individuals, community, and population

6. Systems-level factors that impact continuity of services

7. Behavioral theories and models

C. Enhancing access to care

1. Evidence-based needs assessment of at-risk patients and populations

a. Demographic data

b. Social determinants of health

2. Factors that contribute to risk among patients and populations

a. Age, disability status, education level

b. Physical and mental health status

c. Immigration status, primary language

d. Human trafficking, incarceration status, housing insecurity

e. Exposure to violence and adverse childhood experiences

f. Military status

g. Health and technology literacy

3. Technology use to bridge access gaps

a. Telehealth

b. Remote monitoring and wearable devices

D. Vaccination and immunization as primary prevention

1. Human immune system

a. Adaptive immunity, innate immunity, antibodies, pathogenesis of disease

2. Types of vaccines

a. mRNA, DNA, protein, viral vectors, inactivated viruses, and live attenuated viruses, bacteria, fungi

3. Barriers to immunization at patient, health care professional, and system levels

a. Vaccine hesitancy, belief systems, benefits and risks, exemptions, adverse events

b. Access, clinic and pharmacy location and hours, indications and contraindications

c. Government involvement, state laws and guidelines, media influence, community acceptance, insurance coverage

4. Evidence-based strategies to increase vaccination coverage

a. The Community Guide to Preventive Services

b. Standards for Adult Immunization Practice

c. Standards for Childhood Immunization Practice

5. Immunization information systems (IIS) for tracking immunization status

6. Role of regulatory, advisory, and other bodies in informing the development of national and/or state immunization recommendations

7. Ethical considerations in vaccine delivery

a. Informed consent and informed refusal

b. Confidentiality and privacy

c. Application of ethical principles

d. Communication considerations

Domain 3: Secondary Prevention

A. Assessment of health risks

1. Holistic assessment based on determinants of health

2. Health behaviors at the individual, family, community, and population-levels

3. Risk level categorization to guide appropriate prevention screening

B. Evidence-based screening practices

1. Screening protocols that address the social, structural, and economic needs of individuals, communities, and populations

2. Screening protocols that address physical health, mental health, and substance use

3. Assessment of effectiveness using appropriate outcome measures

4. Benefits, harms, and barriers

5. Evidence-based recommendations and guidelines

a. U.S. Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), World Health Organization (WHO)

b. American Cancer Society, American Diabetes Association, American Heart Association, American Academy of Pediatrics, American Academy of Family Physicians, Immunize.org

6. Metrics for screening validity and effectiveness

a. Range of Normal curve

b. Sensitivity, Specificity

c. Positive and Negative Predictive Value (PPV, NPV)

d. Clinical examples and case studies

C. Universal (mass) and targeted (selective) screening

1. Screenings required by law: newborn screening, lead testing

2. Evidence-based recommended routine screening including, but not limited to cholesterol, blood pressure, glucose, depression, cancer, HIV, STIs, intimate partner violence

3. Screening in special populations

Domain 4: Tertiary Prevention

A. Approaches to preventive therapies and medication

1. Patient education on symptoms and disease progression

2. Routine preventive services

a. Eye exams, dental care, nutrition counseling, home-based monitoring

3. Disease specific preventive services

a. Diabetes management, HIV/AIDS management, cancer care, asthma control

4. Preventive medication

a. Pre-exposure and post exposure prophylaxis

b. Primary and secondary prophylaxis

c. Time-limited medications, long-term medications

5. Rehabilitation across care settings

a. Inpatient, outpatient, home, and community-based

B. Preventive therapies and medications for individual patients

1. Barriers

a. Cost, environmental supports, access, patient literacy and numeracy

2. Belief systems

a. Sociocultural considerations, stigma, religious beliefs, perceived risk of disease, autonomy, individual agency, dependency, media influence

b. Rapport, trust, families, caregivers

3. Efficacy, benefits, and risks

a. Prevention and management of adverse outcomes, comorbidities, contraindications, allergies, chronic disease management, deprescribing, medication reconciliation, rational prescribing, generic medications, patient education, drug information

4. Lifestyle modifications, routines, and habits

a. Dietary changes, exercise, medication adherence

b. Assistive devices, durable medical equipment, device education

C. System-level considerations for preventive therapies and medications

1. Adverse events

a. Reporting systems, documentation requirements

2. Interprofessional coordination

a. Communications with other health care professionals, referrals, electronic medical records

3. Safety

a. Transitions of care, polypharmacy, high-risk conditions, high-risk medications, medication reconciliation, comorbidities

b. Physical, emotional, and psychological safety

4. Socioenvironmental factors

a. Access, uninsured or underinsured, cost-awareness

b. Community resources, role of industry

5. System characteristics

a. Clinical culture, accountability, non-punitive response, attitudes and beliefs about patient populations

b. Delivery systems, payment models

Domain 5: Mental Health, Behavioral Health, and Well-being

A. Access to mental, behavioral, and addiction health services

1. Inpatient, outpatient, and community-based services

a. Telehealth

b. Trauma informed care resources

c. School-based mental health services

d. Access to licensed, credentialed, or board-certified mental health practitioners

2. Peer, family, and caregiver support groups specific to diagnoses

3. Education and support for navigating mental and behavioral health care

4. Barriers that limit access to care

a. Payment for services, prescriptions, transportation

b. Stigma, discrimination

5. Social services navigation

a. housing, food security, legal aid

6. Supportive housing and employment pathways

a. Case management, therapy, life skills

7. Workforce distribution and training on inclusive care practices and disability accommodations

B. Risk assessment and reduction

1. Routine monitoring of emotional and psychological health

a. Early detection of high-risk behaviors and at-risk scenarios

b. Red flag legislation and screening protocols

2. Education for individuals, families, and caregivers about mental health conditions and signs

3. Evidence-based risk prediction models, risk assessment tools, and national guidelines

C. Screening and detection

1. Screening protocol differences for each at-risk group

2. Impact of mental health issues at the individual, community, and population-level

3. Strategies to increase access to mental and behavioral health services across communities and populations

D. Health care professional well-being

1. Root causes and risk factors for burnout

a. Work conditions, institutional culture

b. Personal and community factors

2. Impact of burnout on workforce, patients, organizations, and communities

a. Workforce shortages, increased cost of patient care

3. Strategies to address burnout

a. Preventive education, training and resources

b. Structural supports, belonging, positive work environment

c. Job satisfaction and retention strategies

d. Resilience and adaptability training

e. Clinical ethics consultation services for moral distress

4. Safety

a. Workplace violence

b. Safety policies and protocols

5. Interprofessional team-based practice