Download Periodic Health Exam

Periodic Health Examinations in
Primary Care
DR. KHALED ALDOSSARI
SBFM ,ABFM ,MBBS
Iceberg phenomenon ?
1
Diseased, diagnosed & controlled
2
Diagnosed, uncontrolled
3
Undiagnosed or wrongly
diagnosed disease
4
Risk factors for disease
5
Free of risk factors
Diagnosed
disease
Undiagnosed or
wrongly diagnosed
disease
3
What are PHC physicians doing?
Health Care
Health
promotion
Risk
prevention
Primary Prevention
Risk
reduction
Early
diagnosis
Secondary Prevention
Personal Preventive Medicine!
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Complication
reduction
Tertiary
Prevention
The High mortality diseases in
Saudi Arabia
•
•
•
•
•
•
Symptoms /Signs ill defined ……
24.64%
Diseases of CVS………………... 21.82%
Injury / Poisoning………………. 18.31%
Conditions perinatal period……..
9.88%
Neoplasms………………………
4.55%
Diseases of RS………………….
4.38%
MOH- Saudi Arabia
Definition
Evaluation of apparently health
individuals in certain time periods,
using a number of standard
procedures such as counseling,
physical examination, immunization,
and laboratory investigations is called
Periodic Health Examination.
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Does it work?
• USA: Mortality from stroke has decreased by 50% since 1972
– Early diagnosis and treatment of hypertension
• Mortality from cervix cancer decreased by 80%
• Neonatal screening
– Decrease in mental retardation
• Phenylketonuria screening
• Congenital hypothyroidism
National Center for Health Statistics. http://www.cdc.gov/nchs/r&d/ndi/ndi.htm
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World Health Organization — Principles of
Screening
The Wilson-Jungner Criteria. Public Health Paper 1968,
Geneva, WHO
• The condition should be an important health problem.
• There should be a treatment for the condition.
• Facilities for diagnosis and treatment should be available.
• There should be a latent stage of the disease.
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• There should be a test or examination for the condition.
• The test should be acceptable to the population.
• The natural history of the disease should be adequately
understood.
• There should be an agreed policy on who to treat.
• The total cost of finding a case should be economically
balanced in relation to medical expenditure as a whole.
• Case-finding should be a continuous process, not just a
"once and for all" project.
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Types of screening
•
•
•
•
Mass
Targeted
Multiple or Multiphasic
Case-finding or opportunistic
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How is PHE performed?
• Healthy individuals
•
Counseling
•
Immunization
•
Home visit
•
Prophylaxis
•
Physical exam
•
Laboratory test
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Any Guidelines for KSA?
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Screening / PHE programs in
Saudi Arabia
• Annual periodic health examination for all
diabetic and hypertensive patients
registered at PHC
• Cervical screening
• Breast cancer screening in some areas
• Pre-marital screening (genetic dis.,
infectious dis.)
• Well baby clinic
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USPSTF
Grade Definitions
• Grade Definitions After July 2012
• What the Grades Mean and
Suggestions for Practice ?
Grade
A
Definition
Suggestions for Practice
The USPSTF recommends the service.
Offer or provide this
There is high certainty that the net benefit is service.
substantial.
B
The USPSTF recommends the service.
There is high certainty that the net benefit is
moderate or there is moderate certainty that
the net benefit is moderate to substantial.
Offer or provide this
service.
C
The USPSTF recommends selectively
offering or providing this service to individual
patients based on professional judgment and
patient preferences. There is at least
moderate certainty that the net benefit is
small.
Offer or provide this
service for selected
patients depending on
individual
circumstances.
D
The USPSTF recommends against the
Discourage the use of
service. There is moderate or high certainty this service.
that the service has no net benefit or that
the harms outweigh the benefits.
I
The USPSTF concludes that the current
Read the clinical
Statement evidence is insufficient to assess the
considerations section
balance of benefits and harms of the service. of USPSTF
Evidence is lacking, of poor quality, or
Recommendation
conflicting, and the balance of benefits and Statement. If the
harms cannot be determined.
service is offered,
patients should
understand the
uncertainty about the
balance of benefits
and harms.
Screening for High Blood Pressure
in Adults
• The USPSTF recommends screening
for high blood pressure in adults age
18 and older.
Grade: A Recommendation.
Aspirin for the Prevention of
Cardiovascular Disease
• The USPSTF recommends the use of aspirin for men
ages 45 to 79 years when the potential benefit of a
reduction in myocardial infarction outweighs the
potential harm of an increase in gastrointestinal
hemorrhage.
Grade: A recommendation.
• The USPSTF recommends the use of aspirin for
women ages 55 to 79 years when the potential
benefit of a reduction in ischemic stroke outweighs
the potential harm of an increase in gastrointestinal
hemorrhage.
Grade: A recommendation
• The USPSTF concludes that the current evidence is
insufficient to assess the balance of benefits and
harms of the use of aspirin for cardiovascular
disease prevention in men and women age 80 years
or older.
Grade: I statement.
• The USPSTF recommends against the use of aspirin
for stroke prevention in women younger than age 55
years and for myocardial infarction prevention in
men younger than age 45 years.
Grade: D recommendation.
SCREENING OF DM
• he USPSTF recommends screening for type 2
diabetes in asymptomatic adults with
sustained blood pressure (either treated or
untreated) greater than 135/80 mm Hg.
• Grade: B Recommendation.
• The USPSTF concludes that the current
evidence is insufficient to assess the balance
of benefits and harms of screening for type 2
diabetes in asymptomatic adults with blood
pressure of 135/80 mm Hg or lower.
Screening for Lipid Disorders in
Adults Screening Men
• The U.S. Preventive Services Task
Force (USPSTF) strongly recommends
screening men aged 35 and older for
lipid disorders.
Grade: A Recommendation.
• The USPSTF recommends screening
men aged 20 to 35 for lipid disorders if
they are at increased risk for coronary
heart disease.
Grade: B Recommendation
screening Women at Increased Risk
• The USPSTF strongly recommends
screening women aged 45 and older for
lipid disorders if they are at increased
risk for coronary heart disease.
Grade: A Recommendation.
• The USPSTF recommends screening
women aged 20 to 45 for lipid disorders
if they are at increased risk for
coronary heart disease.
Grade: B Recommendation
Screening Young Men and All
Women Not at Increased Risk
• The USPSTF makes no
recommendation for or against routine
screening for lipid disorders in men
aged 20 to 35, or in women aged 20 and
older who are not at increased risk for
coronary heart disease.
Grade: C Recommendation.
Screening for Thyroid Disease
• The USPSTF concludes the evidence is
insufficient to recommend for or against
routine screening for thyroid disease in
adults.
Grade: I Statement
Screening for Iron Deficiency
Anemia
• The USPSTF concludes that the
evidence is insufficient to recommend
for or against routine screening for iron
deficiency anemia in asymptomatic
children ages 6 to 12 months.
Grade: I Statement.
• The USPSTF recommends routine
screening for iron deficiency anemia in
asymptomatic pregnant women.
Grade: B Recommendation.
Screening for Colorectal Cancer
• The USPSTF recommends screening for colorectal
cancer (CRC) using fecal occult blood testing,
sigmoidoscopy, or colonoscopy, in adults, beginning
at age 50 years and continuing until age 75 years.
The risks and benefits of these screening methods
vary. Grade: A Recommendation.
• The USPSTF recommends against routine screening
for colorectal cancer in adults age 76 to 85 years.
There may be considerations that support colorectal
cancer screening in an individual patient.
Grade: C Recommendation.
• The USPSTF recommends against screening
for colorectal cancer in adults older than age
85 years. Grade: D Recommendation.
• The USPSTF concludes that the evidence is
insufficient to assess the benefits and harms
of computed tomographic colonography and
fecal DNA testing as screening modalities for
colorectal cancer. Grade: I Statement.
Screening for Breast Cancer
• The USPSTF recommends biennial
screening mammography for women
aged 50 to 74 years.
Grade: B recommendation.
• The decision to start regular, biennial
screening mammography before the
age of 50 years should be an individual
one and take patient context into
account, including the patient's values
regarding specific benefits and harms.
Grade: C recommendation.
• The USPSTF concludes that the current
evidence is insufficient to assess the
additional benefits and harms of
screening mammography in women 75
years or older.
Grade: I Statement.
• The USPSTF recommends against
teaching breast self-examination (BSE).
Grade: D recommendation.
Screening for Cervical Cancer
• ANSWER ?
Lung Cancer Screening
• The USPSTF concludes that the
evidence is insufficient to recommend
for or against screening for lung cancer
in asymptomatic persons with either
low-dose computed tomography, chest
x-ray, sputum cytology, or a
combination of these tests.
Screening for Prostate Cancer
• The USPSTF recommends against
PSA-based screening for prostate
cancer.
Grade: D Recommendation.
Screening for Ovarian Cancer
• The USPSTF recommends against
screening for ovarian cancer in women.
Grade: D Recommendation
Screening for Abdominal Aortic
Aneurysm
• The USPSTF recommends one-time screening for
abdominal aortic aneurysm (AAA) by
ultrasonography in men aged 65 to 75 who have ever
smoked.
Grade: B Recommendation.
• The USPSTF makes no recommendation for or
against screening for AAA in men aged 65 to 75 who
have never smoked.
Grade: C Recommendation.
• The USPSTF recommends against routine screening
for AAA in women.
Grade: D Recommendation.
Screening for Depression in Adults
• The USPSTF recommends screening adults for
depression when staff-assisted depression care
supports are in place to assure accurate diagnosis,
effective treatment, and follow-up.
Grade: B recommendation.
• The USPTF recommends against routinely screening
adults for depression when staff-assisted
depression care supports are not in place. There
may be considerations that support screening for
depression in an individual patient.
Grade: C recommendation
Screening for Illicit Drug Use
• The USPSTF concludes that the current
evidence is insufficient to assess the
balance of benefits and harms of
screening adolescents, adults, and
pregnant women for illicit drug use.
Grade: I Statement
Folic Acid to Prevent Neural Tube
Defects
• The USPSTF recommends that all
women planning or capable of
pregnancy take a daily supplement
containing 0.4 to 0.8 mg (400 to 800 µg)
of folic acid .
PHE Suggestions AAFP
 Bacteriuria,
 Asymptomatic The AAFP recommends against the routine screening of
men and nonpregnant women for asymptomatic bacteriuria.
• Breast Cancer
– The AAFP recommends women age 40 years and older be screened for
breast cancer with mammography every 1-2 years after counseling by
their family physician regarding the potential risks and benefits of the
procedure.
• Breast Cancer
– The AAFP concludes that the evidence is insufficient to recommend for
or against teaching or performing routine breast self-examination
(BSE).
 Cardiac Disease
 The AAFP recommends against the use of routine ECG as part of a
periodic health or preparticipation physical exam for cardiac disease in
asymptomatic children and adults.
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PHE Suggestions
 Cervical Cancer
 The AAFP strongly recommends that a Pap smear be completed at
least every 3 years to screen for cervical cancer for women who have
ever had sex and have a cervix.
 Colorectal Cancer
 The AAFP strongly recommends that clinicians screen men and women
50 years of age or older for colorectal cancer.
 Coronary Heart Disease
 The AAFP recommends against routine screening with resting
electrocardiography (ECG), exercise treadmill test (ETT), or electronbeam computerized tomography (EBCT) scanning for coronary calcium
for either the presence of severe coronary artery stenosis (CAS) or the
prediction of coronary heart disease (CHD) events in adults at low risk
for CHD events.
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PHE Suggestions
 Diabetes, Type 2
 The AAFP recommends screening for type 2 diabetes in adults with
hypertension and hyperlipidemia. There is insufficient evidence to
recommend for or against screening adults who are at low risk for
coronary vascular disease.
 Hearing difficulties
 The AAFP recommends screening for hearing difficulties by
questioning elderly adults about hearing impairment and counsel
regarding the availability of treatment when appropriate.
 Hemoglobinopathies
 The AAFP strongly recommends ordering screening tests for PKU,
hemoglobinopathies, and thyroid function abnormalities in neonates.
• Hormone Replacement Therapy
– The AAFP recommends against the routine use of combined estrogen
and progestin for the prevention of chronic conditions in
postmenopausal women.
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PHE Suggestions
• Hormone Replacement Therapy
– The AAFP recommends against the routine use of unopposed estrogen
for the prevention of chronic conditions in postmenopausal women
who have had a hysterectomy.
 Hypertension
 The AAFP strongly recommends that family physicians screen adults
aged 18 and older for high blood pressure.
 Influenza
 The AAFP recommends immunizing all persons age 50 years and older
for influenza. Discuss immunization annually using AAFP
recommendations.
 Lipid Disorders
 The AAFP strongly recommends screening for lipid disorders with
either a fasting lipid profile or nonfasting total cholesterol and HDL
cholesterol in males age 35 and older, and females age 45 and older.
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PHE Suggestions
 Lung Cancer
 The AAFP recommends against the use of chest X-ray and/or sputum
cytology in asymptomatic persons for lung cancer screening.
 Neural tube defects
 The AAFP recommends prescribing 0.4 mg folate supplementation to
women not planning a pregnancy but of childbearing potential who
have not previously had a baby with a neural tube defect.
 Obesity
 The AAFP recommends screening for obesity by measuring height and
weight periodically for all patients.
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