providers/clinical_guidelines_provider.py

"""Clinical Guidelines Provider for USPSTF, CDC, and AHRQ guidelines."""

import logging
from typing import List, Dict, Any, Callable
import httpx

from core.base_provider import BaseProvider
from core.decorators import safe_json_return
from providers import register_provider

logger = logging.getLogger(__name__)

# Evidence-based preventive care guidelines
PREVENTIVE_GUIDELINES = {
    "diabetes_screening": [
        {
            "title": "Type 2 Diabetes Screening",
            "recommendation": "Screen for prediabetes and type 2 diabetes in adults aged 35 to 70 years who have overweight or obesity",
            "grade": "B",
            "age_range": "35-70 years",
            "frequency": "Every 3 years if normal",
            "source": "USPSTF",
            "conditions": ["overweight", "obesity"],
            "citation": "USPSTF 2021"
        }
    ],
    "colorectal_screening": [
        {
            "title": "Colorectal Cancer Screening",
            "recommendation": "Screen for colorectal cancer starting at age 45 years",
            "grade": "A",
            "age_range": "45-75 years",
            "frequency": "Every 10 years (colonoscopy) or annually (FIT)",
            "source": "USPSTF",
            "methods": ["Colonoscopy every 10 years", "FIT annually", "CT colonography every 5 years"],
            "citation": "USPSTF 2021"
        }
    ],
    "hypertension_screening": [
        {
            "title": "Hypertension Screening",
            "recommendation": "Screen for high blood pressure in adults 18 years or older",
            "grade": "A",
            "age_range": "18+ years",
            "frequency": "Annually for adults 40+ or at increased risk; every 3-5 years for adults 18-39 with normal BP",
            "source": "USPSTF",
            "citation": "USPSTF 2021"
        }
    ],
    "cholesterol_screening": [
        {
            "title": "Statin Use for Primary Prevention of CVD",
            "recommendation": "Screen for cardiovascular disease risk factors beginning at age 40",
            "grade": "B",
            "age_range": "40-75 years",
            "frequency": "Every 4-6 years",
            "source": "USPSTF",
            "conditions": ["1+ CVD risk factors"],
            "citation": "USPSTF 2016"
        }
    ]
}

# CDC vaccine schedule recommendations
VACCINE_SCHEDULE = {
    "influenza": {
        "vaccine": "Influenza (Flu)",
        "recommendation": "Annual vaccination for all persons aged 6 months and older",
        "age_groups": ["6 months+"],
        "frequency": "Annually",
        "source": "CDC",
        "priority_groups": ["65+", "Pregnant", "Chronic conditions"]
    },
    "covid19": {
        "vaccine": "COVID-19",
        "recommendation": "Vaccination recommended for all persons 6 months and older",
        "age_groups": ["6 months+"],
        "frequency": "Updated annually",
        "source": "CDC",
        "priority_groups": ["65+", "Immunocompromised", "Healthcare workers"]
    },
    "pneumococcal": {
        "vaccine": "Pneumococcal (PCV/PPSV)",
        "recommendation": "Vaccination for adults 65 years or older and younger adults with certain conditions",
        "age_groups": ["65+", "19-64 with risk factors"],
        "frequency": "One-time or based on risk",
        "source": "CDC",
        "conditions": ["Chronic heart/lung disease", "Diabetes", "Immunocompromised"]
    },
    "shingles": {
        "vaccine": "Shingles (Zoster)",
        "recommendation": "2-dose series for adults 50 years and older",
        "age_groups": ["50+"],
        "frequency": "2 doses, 2-6 months apart",
        "source": "CDC"
    },
    "tdap": {
        "vaccine": "Tdap (Tetanus, Diphtheria, Pertussis)",
        "recommendation": "One dose of Tdap, then Td booster every 10 years",
        "age_groups": ["All adults"],
        "frequency": "Every 10 years",
        "source": "CDC"
    },
    "hepatitis_b": {
        "vaccine": "Hepatitis B",
        "recommendation": "Vaccination for adults at increased risk",
        "age_groups": ["19-59 years (universal)", "60+ with risk factors"],
        "frequency": "2 or 3-dose series",
        "source": "CDC",
        "risk_factors": ["Healthcare workers", "Diabetes", "Chronic liver disease"]
    }
}


@register_provider("clinical_guidelines")
class ClinicalGuidelinesProvider(BaseProvider):
    """Provider for clinical guidelines and preventive care recommendations."""

    def __init__(self, client: httpx.AsyncClient):
        super().__init__("clinical_guidelines", client)

    async def initialize(self) -> None:
        """Initialize clinical guidelines provider."""
        logger.info("Clinical Guidelines provider initialized")

    def get_tools(self) -> List[Callable]:
        """Return all clinical guideline tools."""
        return [
            self.clinical_get_preventive_recommendations,
            self.clinical_get_vaccine_schedule,
            self.clinical_search_guidelines,
            self.clinical_get_lifestyle_recommendations,
            self.clinical_generate_care_plan,
        ]

    @safe_json_return
    async def clinical_get_preventive_recommendations(
        self,
        age: int,
        sex: str,
        conditions: List[str] = None
    ) -> Dict[str, Any]:
        """
        Get personalized preventive care recommendations based on USPSTF guidelines.

        Args:
            age: Patient age in years
            sex: Patient sex (male/female)
            conditions: List of existing conditions (e.g., ["diabetes", "overweight"])

        Returns:
            Evidence-based screening and prevention recommendations with grades
        """
        if conditions is None:
            conditions = []

        recommendations = []
        condition_lower = [c.lower() for c in conditions]

        # Diabetes screening
        if 35 <= age <= 70 and any(c in condition_lower for c in ["overweight", "obesity", "prediabetes"]):
            recommendations.append({
                **PREVENTIVE_GUIDELINES["diabetes_screening"][0],
                "applicable": True,
                "rationale": "Age and BMI criteria met"
            })

        # Colorectal cancer screening
        if 45 <= age <= 75:
            recommendations.append({
                **PREVENTIVE_GUIDELINES["colorectal_screening"][0],
                "applicable": True,
                "rationale": "Age-based screening recommendation"
            })

        # Hypertension screening
        if age >= 18:
            freq = "Annually" if age >= 40 else "Every 3-5 years"
            rec = PREVENTIVE_GUIDELINES["hypertension_screening"][0].copy()
            rec["frequency"] = freq
            rec["applicable"] = True
            rec["rationale"] = "Universal screening for adults"
            recommendations.append(rec)

        # Cholesterol/CVD screening
        if 40 <= age <= 75:
            recommendations.append({
                **PREVENTIVE_GUIDELINES["cholesterol_screening"][0],
                "applicable": True,
                "rationale": "Age-based cardiovascular risk screening"
            })

        # Sex-specific screenings
        if sex.lower() == "female":
            if 40 <= age <= 74:
                recommendations.append({
                    "title": "Breast Cancer Screening",
                    "recommendation": "Biennial screening mammography for women aged 40-74",
                    "grade": "B",
                    "age_range": "40-74 years",
                    "frequency": "Every 2 years",
                    "source": "USPSTF",
                    "applicable": True,
                    "citation": "USPSTF 2024"
                })
            if 21 <= age <= 65:
                recommendations.append({
                    "title": "Cervical Cancer Screening",
                    "recommendation": "Screening every 3 years with cytology (21-29) or every 5 years with HPV testing (30-65)",
                    "grade": "A",
                    "age_range": "21-65 years",
                    "frequency": "Every 3-5 years based on method",
                    "source": "USPSTF",
                    "applicable": True,
                    "citation": "USPSTF 2018"
                })
        elif sex.lower() == "male":
            if 55 <= age <= 80 and "smoking history" in condition_lower:
                recommendations.append({
                    "title": "Lung Cancer Screening",
                    "recommendation": "Annual screening with low-dose CT for adults 50-80 with 20 pack-year smoking history",
                    "grade": "B",
                    "age_range": "50-80 years",
                    "frequency": "Annually",
                    "source": "USPSTF",
                    "applicable": True,
                    "conditions": ["20 pack-year smoking history"],
                    "citation": "USPSTF 2021"
                })

        return {
            "patient_age": age,
            "patient_sex": sex,
            "conditions": conditions,
            "recommendations": recommendations,
            "total_recommendations": len(recommendations)
        }

    @safe_json_return
    async def clinical_get_vaccine_schedule(
        self,
        age: int,
        conditions: List[str] = None
    ) -> Dict[str, Any]:
        """
        Get personalized vaccine recommendations based on CDC guidelines.

        Args:
            age: Patient age in years
            conditions: List of health conditions

        Returns:
            Recommended vaccines with timing and priority
        """
        if conditions is None:
            conditions = []

        recommended_vaccines = []
        condition_lower = [c.lower() for c in conditions]

        # Universal vaccines
        recommended_vaccines.append({
            **VACCINE_SCHEDULE["influenza"],
            "due": "Annually, preferably before flu season (Sept-Oct)",
            "priority": "High" if age >= 65 or len(conditions) > 0 else "Standard"
        })

        recommended_vaccines.append({
            **VACCINE_SCHEDULE["covid19"],
            "due": "Check for updated formulation annually",
            "priority": "High" if age >= 65 else "Standard"
        })

        # Age-specific vaccines
        if age >= 65:
            recommended_vaccines.append({
                **VACCINE_SCHEDULE["pneumococcal"],
                "due": "If not previously vaccinated",
                "priority": "High"
            })

        if age >= 50:
            recommended_vaccines.append({
                **VACCINE_SCHEDULE["shingles"],
                "due": "2-dose series if not previously vaccinated",
                "priority": "High" if age >= 60 else "Standard"
            })

        # Condition-specific
        if any(c in condition_lower for c in ["diabetes", "heart disease", "lung disease", "immunocompromised"]):
            if age >= 19 and age < 65:
                recommended_vaccines.append({
                    **VACCINE_SCHEDULE["pneumococcal"],
                    "due": "Based on risk factors",
                    "priority": "High",
                    "rationale": "Chronic medical condition"
                })

        # Tdap (universal adult)
        recommended_vaccines.append({
            **VACCINE_SCHEDULE["tdap"],
            "due": "If not received in last 10 years",
            "priority": "Standard"
        })

        # Hepatitis B
        if 19 <= age <= 59:
            recommended_vaccines.append({
                **VACCINE_SCHEDULE["hepatitis_b"],
                "due": "If not previously vaccinated",
                "priority": "Standard"
            })

        return {
            "patient_age": age,
            "conditions": conditions,
            "recommended_vaccines": recommended_vaccines,
            "total_vaccines": len(recommended_vaccines)
        }

    @safe_json_return
    async def clinical_search_guidelines(
        self,
        query: str,
        source: str = "All"
    ) -> Dict[str, Any]:
        """
        Search clinical guidelines by condition or screening type.

        Args:
            query: Search term (condition, screening type, etc.)
            source: Filter by source (USPSTF, CDC, AHRQ, All)

        Returns:
            Matching guidelines with recommendations
        """
        query_lower = query.lower()
        results = []

        # Search preventive guidelines
        for key, guidelines in PREVENTIVE_GUIDELINES.items():
            if query_lower in key:
                results.extend(guidelines)
            else:
                for g in guidelines:
                    if query_lower in g.get("title", "").lower():
                        results.append(g)

        # Search vaccines
        for key, vaccine in VACCINE_SCHEDULE.items():
            if query_lower in key or query_lower in vaccine.get("vaccine", "").lower():
                results.append({
                    "title": vaccine["vaccine"],
                    "recommendation": vaccine["recommendation"],
                    "source": vaccine["source"],
                    "type": "Immunization",
                    "age_groups": vaccine.get("age_groups", []),
                    "frequency": vaccine.get("frequency", "")
                })

        # Filter by source if specified
        if source != "All":
            results = [r for r in results if r.get("source", "").upper() == source.upper()]

        return {
            "query": query,
            "source_filter": source,
            "results": results,
            "total": len(results)
        }

    @safe_json_return
    async def clinical_get_lifestyle_recommendations(
        self,
        conditions: List[str],
        age: int
    ) -> Dict[str, Any]:
        """
        Get evidence-based lifestyle and wellness recommendations.

        Args:
            conditions: List of health conditions
            age: Patient age

        Returns:
            Lifestyle modification recommendations
        """
        if conditions is None:
            conditions = []

        recommendations = []
        condition_lower = [c.lower() for c in conditions]

        # Universal recommendations
        recommendations.append({
            "category": "Physical Activity",
            "recommendation": "At least 150 minutes of moderate-intensity aerobic activity per week",
            "source": "CDC Physical Activity Guidelines",
            "evidence_grade": "A"
        })

        recommendations.append({
            "category": "Nutrition",
            "recommendation": "Mediterranean-style diet rich in fruits, vegetables, whole grains, and healthy fats",
            "source": "AHA Dietary Guidelines",
            "evidence_grade": "A"
        })

        recommendations.append({
            "category": "Sleep",
            "recommendation": "7-9 hours of sleep per night for adults",
            "source": "CDC Sleep Guidelines",
            "evidence_grade": "A"
        })

        # Condition-specific
        if "diabetes" in condition_lower:
            recommendations.append({
                "category": "Diabetes Management",
                "recommendation": "Monitor blood glucose regularly, aim for HbA1c <7% for most adults",
                "source": "ADA Standards of Care",
                "evidence_grade": "A",
                "specifics": ["Carbohydrate counting", "Regular foot examinations", "Annual eye exams"]
            })

        if "hypertension" in condition_lower:
            recommendations.append({
                "category": "Blood Pressure Management",
                "recommendation": "DASH diet, sodium restriction (<2300mg/day), regular BP monitoring",
                "source": "ACC/AHA Hypertension Guidelines",
                "evidence_grade": "A",
                "target": "BP <130/80 mmHg"
            })

        if any("heart" in c or "cardiac" in c or "cardiovascular" in c for c in condition_lower):
            recommendations.append({
                "category": "Cardiovascular Health",
                "recommendation": "Cardiac rehabilitation if eligible, cholesterol management, smoking cessation",
                "source": "AHA/ACC Guidelines",
                "evidence_grade": "A"
            })

        if "obesity" in condition_lower or "overweight" in condition_lower:
            recommendations.append({
                "category": "Weight Management",
                "recommendation": "5-10% weight loss through caloric reduction and increased physical activity",
                "source": "USPSTF Obesity Guidelines",
                "evidence_grade": "B"
            })

        return {
            "conditions": conditions,
            "patient_age": age,
            "recommendations": recommendations,
            "total": len(recommendations)
        }

    @safe_json_return
    async def clinical_generate_care_plan(
        self,
        age: int,
        sex: str,
        conditions: List[str] = None,
        current_medications: List[str] = None
    ) -> Dict[str, Any]:
        """
        Generate comprehensive 6-month care plan with screening, vaccines, and lifestyle.

        Args:
            age: Patient age
            sex: Patient sex
            conditions: Existing conditions
            current_medications: Current medication list

        Returns:
            Structured 6-month care plan
        """
        if conditions is None:
            conditions = []
        if current_medications is None:
            current_medications = []

        # Get all recommendation types
        preventive = await self.clinical_get_preventive_recommendations(age, sex, conditions)
        vaccines = await self.clinical_get_vaccine_schedule(age, conditions)
        lifestyle = await self.clinical_get_lifestyle_recommendations(conditions, age)

        # Build timeline
        care_plan = {
            "patient_profile": {
                "age": age,
                "sex": sex,
                "conditions": conditions,
                "current_medications": current_medications
            },
            "preventive_screenings": preventive.get("recommendations", []),
            "immunizations": vaccines.get("recommended_vaccines", []),
            "lifestyle_modifications": lifestyle.get("recommendations", []),
            "timeline": {
                "month_1": ["Schedule overdue screenings", "Update immunizations"],
                "month_2": ["Follow up on screening results", "Begin lifestyle modifications"],
                "month_3": ["Medication review with provider", "Assess lifestyle progress"],
                "month_6": ["Comprehensive health review", "Update care plan"]
            },
            "follow_up_schedule": {
                "primary_care": "Every 3-6 months" if conditions else "Annually",
                "specialist": "As indicated by conditions" if conditions else "Not required",
                "lab_work": "Per screening recommendations"
            }
        }

        return care_plan