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Optimizing Women's Health: Adult Women's Health & Medicine

Posted on: Sunday, 18 September 2005, 03:00 CDT

Key words: ADULT WOMEN'S HEALTH AND MEDICINE, WELL WOMAN CARE, HEALTH PROMOTION, DISEASE PREVENTION, EDUCATION, HEALTH-CARE PROFESSIONALS, FUNCTIONAL HEALTH THRESHOLD

DEFINING THE CONCEPT

The concept of Adult Women's Health and Medicine (AWH&M) is based on the premises that, first, many of the conditions associated with chronic ill health in women develop in early childhood (Figure 1) and, second, true primary prevention of these conditions has to commence well before the menopause. Hence, the definition of AWH&M is derived as 'the holistic care of women from the age of 16 to 65 years'. Although this age span is somewhat arbitrary, the health care of women of this age best addresses the missions and goals of the AWH&M project of the International Menopause Society (IMS). This age category also avoids professional conflict with the designated interests of pediatricians (patients younger than 16 years), the practice of geriatrics (patients older than 65 years), or the care of older women who initially present with medical problems, for example, myocardial infarction, stroke or hip fracture. In short, AWH&M is best considered as ambulatory well woman care. The actual practice may need to be modified to meet the specific health-care requirements of given societies and their medical communities. As such, the defined age span and type of practice may vary regionally but the principal mission and goal will remain intact: health promotion and disease prevention.

THE MISSION

The mission of the AWH&M Project is the provision of optimal care for adult women based on the biology of aging in women, the pathogenesis of defined conditions and diseases, and the application of established and evolving diagnostic tests and therapeutic choices to promote good health and to prevent and/or delay/ameliorate the emergence of disease.

THE SCIENCE

The principle of AWH&M is founded on validated science. This includes the incorporation of data from published basic and experimental biological studies, observational and randomized clinical trials - both surrogate marker and clinical end-point - and clinical experience. The information base is thus determined by experts from various disciplines and judiciously adapted to clinical practice with one universal objective: optimizing the health of women through individualized assessment and care.

The latter is facilitated by advances in diagnostic and therapeutic technology which now allow for the early diagnosis of disease and the integration and tailoring of various treatment modalities to meet this need according to a woman's life stage (Figure 2). Future advances in genomic medicine - diagnostic and pharmacological - will permit an even more specific and targeted approach to disease prevention and treatment.

Figure 1 Health-care needs by life stage

Figure 2 Management of health-care needs by life stage

THE TARGET PATIENT POPULATIONS

Primary age group: 35-65 years

This age group represents women who are aware of age- and reproductive-related changes. These women are receptive to preventive interventions (mammograms, bone density tests, etc.) and can influence the optimal target population: women age 16-35 years. Intermediate health-care costs are involved.

Secondary age group: 16-35 years

This is the target audience that will benefit most from true primary prevention via management principles: exercise, nutrition, and lifestyle. The health costs are low.

Tertiary age group: well elderly (> 65 years)

Care of this group must be differentiated from geriatric care. The health costs are high, involving diagnostic tests and therapeutics.

THE PRACTICE

AWH&M is ambulatory (out-patient) medicine for adult women.

(1) Management: education and/or actual practice of evaluating, modifying, adjusting and prescribing nutrition, exercise and lifestyle advice.

(2) Clinical evaluation of the health status of women across their life cycle: utilization and interpretation of diagnostic technologies for early diagnosis of disease as aids to therapeutic decisions and monitoring of care.

(3) Utilization and prescribing of hormonal and disease-specific therapies based on biological, pathological and pharmacological principles. The approach is balanced with randomized controlled trial studies, both surrogate marker and outcome research.

(4) Non-competitive practice: unless the program participant is appropriately qualified, the AWH&M curriculum will not include:

(a) Evaluation and treatment of overt disease: stroke, myocardial infarction, fracture, etc.;

(b) Gynecology and reproductive (including obstetrics) medicine other than contraception and age-related gynecological problems, e.g. atrophic vaginitis;

(c) Urologic interventions, but may include evaluation of genitourinary problems such as incontinence;

(d) Inpatient (hospital) care.

THE GOAL

The goal of the International Menopause Society's global AWH&M initiative is the education and the training of health-care professionals in adult women's health and medicine. Two educational programs are planned.

Education vs. training of health-care professionals in AWH&M

(1) CME seminars aimed at educating established health-care professionals (primarily MDs) in the principles and practice of AWH&M;

(2) Training and certification of health-care professionals in the practice of AWH&M: this would result in a new sub-specialty of Adult Women's Health generalists (primarily nurses, nurse practitioners and other suitably qualified health professionals);

(3) Both of the above methods.

'THE ROAD MAP'

The AWH&M project is to be developed in two phases: Train the Teacher and Teach the Practitioner workshops. Both programs will be preceded by regional Curriculum Council meetings. Each Curriculum Council meeting will be held under the co-chairmanship of a convenor from a given National Menopause Society or recognized national health-care organization and a representative from the IMS to ensure that the purpose and goals of the AWH&M project are met. Participants at these meetings will include senior representatives of the various disciplines relevant to the AWH&M concept. Their collective advice will be needed, both to better understand their specialty societies' interests and to assist with the development of the AWH&M curriculum.

Figure 3 Concept template for adult women's medicine: cost- benefit of health promotion and disease prevention

Figure 4 Compression of morbidity with aging: raising the functional health threshold. Reproduced from Notelovitz M. The Adult Woman's Health Plan. In Schneider HPG, ed. Menopause: the State of the Art - in Research and Management. London: Parthenon Publishing, 2003:502-7. Adapted from Fries and Crapo, 1980

Each Council meeting will develop a nationspecific curriculum for their Train the Teacher workshop. The course will subsequently be modified by the latter group for a series of didactic 'how to' Teach the Practitioner workshops.

AWH&M: A SOCIETAL NEED

With the explosion of both the aging population and the cost of health care, preventive medicine can no longer be considered a 'luxury' relevant only to wealthy societies and nations. As reflected in the Clinical Practice and Cost template (Figure 3), the higher the standard of preventive care (healthy lifestyle; few tests) in young adulthood, the lower the eventual diagnostic and drug costs will be for middle-aged and especially for older women (65 years and above). Conversely, by raising the 'functional health threshold' premenopausally, older women can anticipate an improved and longer meaningful and active lifespan (Figure 4). In short, by appreciating the biology of aging - normal and abnormal - in women, AWH&M has evolved into a clearly identifiable science, clinical practice, and an important global societal need.

Morris Notelovitz

Director of Development, International Menopause Society

Correspondence: Dr M. Notelovitz, 4279 NW 61 Lane, Boca Raton, FL 33496, USA

Copyright CRC Press Sep 2005

Source: Climacteric

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