Opportunity for Optimization and Integration A View from the Field

Military Medicine, Mar 2008 by Sloan, Robert

Disclaimer: The opinions or assertions are those of the author and do not necessarily reflect those of the United States Navy Medical Department or the Department of Defense.

Recently, the new Operational Naval Instruction 6100.2A was released, providing a policy for health promotion and wellness services within the Department of the Navy. The policy seeks to "integrate the activities of medical, dental, military personnel, family members, civilian personnel, training, supply, safety, public affairs, Morale, Welfare, and Recreation, research, and Command Fitness Leaders in support of the Health and Wellness Promotion Program."(1) Currently, there are several policies in place which seek to maintain and augment the force health protection and readiness of service members. In the field, however, these policies are not well integrated. This editorial will seek to propose ideas of linking and augmenting existing services within the Department of the United States Navy to improve the force health protection and readiness of service members in relation to Physical Fitness Assessment (PFA) and Periodic Health Assessment (PHA) programs.

The purpose of Health Assessment Policy 06-006 is to give the Armed Forces guidance on the implementation of the PHA (2). Moreover, the policy is designed to enhance the force health protection and readiness of service members by providing an annual multiphasic preventive screening and surveillance program which seeks to consolidate medical, occupational, health, and risk screening services, along with medical record review, preventive counselling, and risk communication. Most medical treatment facilities attempt to accommodate service members during their birth month by offering a PHA system which is designed to be a one-stop-shop. However, at the recent 46th Annual Occupational Health & Preventive Medicine Conference sponsored by the Navy Environmental Health Center, the majority of PHA coordinators from the field stated that this one-stop-shop system was not always possible. On a broader scale, the PHA program serves as a portal for service members to update and complete all individual medical readiness (IMR) requirements and serves as the mechanism to clear or waive service members for the U.S. Navy's bi-annual physical fitness assessment (3). Once the PHA process is completed, service members are cleared to participate in the PFA for 12 months from that PHA completion date unless any new medical factors arise in that time period identified on the physical activity risk factor questionnaire.

Department of Defense Instruction 1308.3 is designed to provide a policy for health and fitness which contributes to the overall force, health protection, and readiness of the Armed Forces. Specifically, the Armed Forces are instructed to accomplish this by instituting programs in which "Service members shall maintain physical readiness through appropriate nutrition, health, and fitness habits. Aerobic capacity, muscular strength, muscular endurance, and desirable body fat composition form the basis for the Department of Defense Physical Fitness and Body Fat programs."(4) In order to enhance the PFA, the Navy has recently added more choices for aerobic capacity testing that generally require individualized supervision and testing. Furthermore, the PFA serves as a challenge for most Command Fitness Leaders to complete and may cause a substantial drain on command manpower and productivity. Generally, the position of the Command Fitness Leader is considered a collateral duty for the assigned service member, but the task often becomes a primary responsibility or burden interfering with daily productivity. Currently, there are approximately 5425 registered Command Fitness Leaders in the Navy. The large number and constant turnover of Command Fitness Leaders involved with fitness testing on a bi-annual basis leads to concerns with the overall concordance of the PFA body composition assessment.

With policies and instructions intact, this may be an opportune time for the Navy to consider the integration and optimization of PHA and PFA programs that would aim to centralize these programs. This action would: decrease service member time away from work, increase reliability of the PFA, and improve the safety of cardiovascular fitness testing for service members. Optimally, in order to facilitate this process, PHA and PFA staff would be centrally located in a readiness center.

The following itemized list is designed for review and comment to help facilitate ideas on how this system may be integrated optimized. Keep in mind that individual service members should contact the readiness center for their annual appointment within 30 days of their respective birth date.

1. The PHA visit consists of a face to face encounter, assessment, and review of a service member's vital signs, medical records, medical history, and Health Assessment Review Tool-Readiness. If any of the IMR elements are identified to be delinquent, the service member is directed on how to update their IMR status. Within the readiness center, the IMR elements can be updated. The IMR elements are: PHA, no deployment-limiting conditions, dental readiness, immunization status, medical readiness laboratory tests, and individual medical equipment. A privileged provider should then provide counselling and guidance on the results of the PHA.