Primary care
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Declining cervical cancer rates in the United States highlights the value of prevention and early detection of premalignant cervical disease afforded by the human papillomavirus vaccine and Pap smear. The availability of in-office loop electrosurgical excision procedure affords clinicians with a cost-effective and preferred tool for the excision of high-grade lesions of the cervix with minimal risk for severe adverse outcomes. The most recent American Society for Colposcopy and Cervical Pathology guidelines recommend a risk-based approach for the detection, treatment, and surveillance of cervical disease and specifically focus on the risk of developing cervical intraepithelial neoplasia 3 or worse histology.
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In an era where cardiovascular disease continues to increase in prevalence, chest pain is a commonly encountered complaint in the outpatient setting. Clinicians are often tasked with the challenge of selecting the most appropriate screening tool in the evaluation of a patient with suspected coronary artery disease. With proper consideration of indications and contraindications, exercise electrocardiogram (ECG) stress testing is an accessible, cost-conscious, and validated outpatient diagnostic modality for predicting coronary artery disease.
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Intrauterine devices (IUDs) are safe, highly effective, reversible contraception and come in 2 varieties in the United States: nonhormonal (copper) or levonorgestrel hormonal (LNG) IUDs. There are few absolute contraindications, making them appropriate birth control for most patients. Patients are more likely to select an IUD when counseled about IUD removal and factors that are important to them. IUD insertion and removal are uncomplicated office procedures that can be offered by primary care providers.