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ScreeningScreening

Introduction to Primary Care: a course of the Center of Post Graduate Studies in FM

PO Box 27121 – Riyadh 11417Tel: 4912326 – Fax: 4970847

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Objectives

• Describe the role of Periodic Health Examination (PHE) in primary care

• Count three diseases with highest mortality

• Mention PHE guideline resources

• Explain the effective screening criteria used in PHE

• Aware of the risks in PHE

• Aware of the importance of PHE and preventive medicine in primary care.

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1 Diseased, diagnosed & controlled

2 Diagnosed, uncontrolled

3 Undiagnosed or wronglydiagnosed disease

4 Risk factors for disease

5 Free of risk factors

Diagnosed disease

Undiagnosed orwrongly diagnosed

disease

Iceberg phenomenon ?

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

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Evidence Based Recommendations

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Screening

Screening involves the utilization of a

diagnostic procedure to check for the presence

of a disease prior to the manifestation of

clinical symptoms

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The goal of screening and evaluation is to

prevent the onset of disease or the worsening

of an existing disease.

For example, measurement of blood pressure

is intended to detect hypertension so as to

initiate treatment and prevent subsequent

morbidity (e.g., stroke or renal failure) or mortality.

Goal of screening

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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.

• 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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Risk in Screening

• Adverse effects of screening procedure (e.g. Stress,

anxiety, radiation exposure, chemical exposure).

• Stress and anxiety caused by a “False Positive” screening

result.

• Unnecessary investigation and treatment of false positive

results.

• Prolonging knowledge of an illness if nothing can be done about it.

• A false sense of security caused by false negatives, which may even delay final diagnosis.

• Overuse/waste of medical resources. • Unnecessary and uncomfortable procedures

looking for a disease that is unlikely

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Periodic Health Examination

The purpose of the periodic health

examination is to evaluate health status,

screen for risk factors and disease, and

provide preventive counseling interventions in

an age-appropriate manner

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Importance of PHE

• Educate patients about behavioral patterns or environmental exposures that pose risks for future diseases.

• Examples include– counseling about smoking prevention and cessation to

prevent lung cancer and emphysema, – seat belt use to prevent motor-vehicle injuries,

or – modifying sexual practices to prevent the

spread of sexually transmitted disease.

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1. AAFP recommended periodic-health-examinationwww.aafp.org/fpr/970300fr/5.html

2. Canadian Task Force on Preventive medicine.www.ctfphc.org

3. NHS Screening. www.screening.nhs.uk 4. PHE.www.answers.com/topic/periodic-

health-examination 5. PHE. www.enotes.com/public-health-

encyclopedia/periodic-health-examination

Sources for information of PHE

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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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• Counseling during the periodic health examination is also very important, for this is where physicians recommend changes in lifestyle that can affect future morbidity and mortality – Premarital– Risky behaviours

• Smoking

– According to age group– Healthy diet– Exercise...

Counseling

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Thanks