the periodic health examination
TRANSCRIPT
The Periodic Health Examination
Mek Villafuerte-Solana, MD, DFM
What is the PHEX?
• A series of “interventions” (medical history, PE, lab tests, immunization, counseling) offered to healthy individuals to reduce their risk of developing certain health problems
• May be offered to patients with health problems but with no signs and symptoms of the conditions for which screening tests are advised
Use of the PHEX
• Offer an opportunity to establish and maintain patient-MD relationship
• Emphasize the importance of health-related behavior
• Encourage proven screening maneuvers for common diseases
• Detect unrecognized medical conditions
Major Objectives of the PHEX
• PRIMARY PREVENTION- to prevent the development of a dse by acting on risk factors or on the environment
• SECONDARY PREVENTION- detect early anomalies suggesting the existence of a developing pathology before the patient reports any signs and symptoms
How Important are Risk Factors?
• Attributes associated with target conditions• Help predict outcomes but may not cause
the target conditions• Include demographic variables such as
gender, ethnicity, age, behavioral risk factors, and environmental factors
Screening for Diseases
• Screening is a form of secondary prevention, applied broadly to an unselected population
• RATIONALE:– Secondary prevention requires that we detect
disease as early as possible, so that early intervention will become more successful
SCREENING
• Process by which unrecognized disease or defects are identified by tests which can be applied rapidly on a large scale
• Screening tests distinguish apparently healthy people from those who probably have the disease
Criteria for Screening
• FOR THE DISEASE– Should be serious- e.g. burden in terms of
death, disability, discomfort– Should have a defined pre-clinical stage– Natural history is understood– Should have a long period between first signs
and overt disease
Natural History of Disease
Biological onset of disease Detectable
by screening
symptoms diagnosis therapy
outcome
Lead time
Pre-clinical phase Clinical phase
Criteria for Screening
• FOR DIAGNOSIS AND TREATMENT
1. Facilities should be adequate
2. There should be an available, effective, safe, and acceptable treatment
3. Early treatment should be more effective than later treatment
Criteria for Screening
• THE TEST1. Should be sensitive and specific
2. Simple and cheap
3. Safe and acceptable
4. Reliable
PERIODIC HEALTH EXAM
RISK ASSESSMENT
LIFESTYLE CHECK
SCREENING
VACCINES
CHEMOPROPHYLAXIS
RISK ASSESSMENT
• Basis is still a comprehensive clinical history – Past medical and surgical history (childhood
illnesses)– Immunizations given– Medications (prescriptions and over the
counter, supplements)– Disabilites / handicaps
• and pertinent physical examination
RISK ASSESSMENT
• General Data (age, sex, educational level, socio-economic status)
• Family History (genogram)• Personal Social History (include lifestyle
check, stressors and coping mechanisms)• Basic Physical Examination (height,
weight, BMI, waist circumference…)
PHEX COMPONENTS: FROM BIRTH TO 10 YEARS
• SCREENING– Height and weight every visit– Blood pressure every visit– Vision screening (age 3-4) using Snellen chart– Newborn screen (galactosemia, phenylalanine
deficiency, hypothyroidism, G-6PD deficiency, 21-hydroxylase deficiency)
– For high risk groups only: PPD, blood lead level (6 months to 6 years)
PHEX COMPONENTS: FROM BIRTH TO 10 YEARS
• COUNSELING– Injury Prevention
• Child safety car seats, use of lap shoulder belts, helmet
• Window/stair guards• Safe storage of drugs and harmful chemicals
– Diet and Exercise- be specific according to identified risks, stress for breastfeeding
– Substance use if any– Dental health- regular visit to dentist, use of
floss, baby bottle tooth decay
PHEX COMPONENTS: FROM BIRTH TO 10 YEARS
• IMMUNIZATIONS– DPT, OPV, MMR– H. influenza type B (Hib)– Hepatitis B– Varicella
• CHEMOPROPHYLAXIS– Multivitamins– Iron– Vitamin C
PHEX COMPONENTS: FROM 11 TO 24 YEARS
• SCREENING– Height and weight, BMI every visit– Blood pressure– Pap smear at age 18 or once sexually active-
done yearly for 3 years then every 3 years– Rubella serology or history of measles or
MMR vaccination– CAGE test for problem drinking
PHEX COMPONENTS: FROM 11 TO 24 YEARS
• COUNSELING– Injury prevention
• Lap/shoulder belts• Use of bicycle or motorcycle helmets• Smoke detector
– Substance Use-smoking, alcoholism, drugs– Sexual behavior- STD prevention,
contraceptions, unintended pregnancy– Diet and exercise- limit cholesterol, increase
fiber intake, regular physical activity– Dental health
PHEX COMPONENTS: FROM 11 TO 24 YEARS
• IMMUNIZATIONS– Tetanus-diphtheria booster- every 10 years– Hepatitis B– MMR, Varicella– Influenza yearly-patient preference– For high risk groups: Pneumococcal vaccine
every 5 years
• CHEMOPROPHYLAXIS:– Multivitamins with folic acid– Calcium
PHEX COMPONENTS: FROM 25 to 64 years
• SCREENING– BP, Height, weight, BMI– Lipid profile (men: 35-65 yrs old, for women: 45-65
yrs old)– Pap smear yearly for 3 years, if normal, evry 3 years
thereafter– Mammogram +/- clinical breast exam (women 50-69
yr old)- yearly– Fecal occult blood test (FOBT) &/or sigmoidoscopy
(≥50 yr)– Rubella serology or vaccination hx– CAGE test for problem drinking
PHEX COMPONENTS: FROM 25 to 64 years
• COUNSELING– Substance use- smoking, alcohol, drugs– Diet and exercise– Injury prevention– Sexual behavior– Dental health
PHEX COMPONENTS: FROM 25 to 64 years
• IMMUNIZATIONS– Td boosters– Rubella for women of childbearing age
• CHEMOPROPHYLAXIS– Multivitamins – Folic acid- for those planning pregnancy– Calcium– Hormone replacement therapy-patient
preference
PHEX COMPONENTS: FROM 65 years and older
• SCREENING– BP, Height, weight, BMI– Lipid profile (men: 35-65 yrs old, for women: 45-65
yrs old)– Pap smear yearly for 3 years, if normal, evry 3 years
thereafter– Mammogram +/- clinical breast exam (women 50-69
yr old)- yearly– Fecal occult blood test (FOBT) &/or sigmoidoscopy
(≥50 yr)– Vision screening, hearing impairment screening– CAGE test for problem drinking
PHEX COMPONENTS: FROM 65 years and older
• COUNSELING– Substance use- smoking, alcohol, drugs– Diet and exercise– Injury prevention
• Aside from previously stated, fall/slip prevention, CPR training for household members
– Sexual behavior– Dental health
PHEX COMPONENTS: FROM 65 years and older
• IMMUNIZATIONS– Td boosters– Influenza yearly– Pneumococcal every 5 years
• CHEMOPROPHYLAXIS– Multivitamins – Hormone replacement therapy-patient
preference– Calcium
PHEX= Wellness Plan
• Lifestyle inventory including trans-theoretical stage (for those behavior that needs to be changed)
• Screening requirements based on the PHE• Vaccines required (indicate if already
given)• Chemoprevention
WELLNESS PLAN REPORT: personal and
familyI. RISK ASSESSMENT• Risk factors identified
II. LIFESTYLE CHECK• Among your list of unhealthy behaviors, choose one
behavior and propose a strategy to use to change it based on stage of readiness
III. SCREENING TESTS• Exams that you need to request for yourself and your
family
IV. VACCINES• Vaccines that you and you r family members still need
to get
V. CHEMOPREVENTION• Drugs you need to take to prevent illness based on risk
factors identified