Philippine Guidelines On Periodic Health Examination (PHEx) PDF
Philippine Guidelines On Periodic Health Examination (PHEx) PDF
Philippine Guidelines On Periodic Health Examination (PHEx) PDF
IN THIS SECTION
In the l'att half century, heahh care hat seen a najor thft in phik:ophltfrom curatiue
melirine to
preuentiuc medicine. Medical education has euolued, tonetiet
on preuenti)e"iedicine haue beenforned,
natiorul and international agenciet haue been set-up, and heahi budgetu haue
been reallocated - a// in
illpport of tbis inpottail.thzft in nedical thinking. In the procit, the concept of health care has
evaped the confnu of 'c/inics and horprtah, expanding into thi publit' arena, to'inc/'ude horrr, ,rhoo,/,
and the workplarc.
Thus far, four rnajor strategies have : Sirfall*of Scrernit$ e*rd Otlier
been,used in the tapidly gtowing field of
"',P$rmntiw,,ltedicine,$ttategies
preventive.medicine. These include 1)
health screening (doing tests for eady
Just like in curative medicine, the
detection of disease or risk factors for biggest pitfall in disease prevention is that
disease),2) Iifestyle change (avoidance of things that ought to work do not always
unhealthy habits), 3) risk factor control do so. For example, some lifestyle
(treatment of factors that predispose to changes, such as salt restriction, have
disease), and 4) vaccinarion programs failed to lead to appreciable changes in
(immunization against infectious the incidence of sftoke and coronary
diseases). Health screening is often
disease in the general population. ' Most
referred to as the cornerstone of disease
dietary maneuvers, like high Ftber diet,
prevention, and although it often ovedaps have not been proven effective in cancer
with the latter three strategies, it is the prevention.' Risk factor control has
main focus of this book. '
failed as well, and in sorle instances, has
even led to an increase in deaths. The
The World Health Organization cholesterol lowedng drug clofibrate, for
(1994) defines screening as the use of example, was removed from the market
presumptive methods to detect because a tial by the Wodd Health
unrecognized health risks or Organization shovzed more deaths
asymptomatic disease in apparently among patients vrho teceived the
healthy individqals in order to permit
treatment..s
prevention and timely intervention. t.
Screening is performed to categorize
Even the strategy of screening
members of the general public into (executive check-ups) has had its failures.
those with higher or lower probability Many tests,
of disease, with the former group such as the
electrocardiogram", have been found to
being utged to seek further medical be inaccurate for detection of eady
attention for definitive diagnosis and coronaty disease. As a result, many
treatfirent.3 asymptbmatic patients wrongly
^te
OOall#ffiffi,ri*,..
labeled as being "ill." Instead of 1. Treatment fot the asymPtomatic
improving the quality of life of people, condition must have been
this phenomenon of "false labeling"'has evaluated using well-designed
been found to wreak havoc on the social, tandomized controlled trials that
psychological, physical and even financial observed effects on clinical
stability of unfortunate individuals. outcomes.
Otherwise ptoductive people have been
denied insutance ot empioyment, or have It is easy to comPrehend that if we
resigned from work because of spend millions of Pesos to detect a
depression. Many times, the side effects disease fot which thete is no effective
of scteening have been fat worse than the treatrent, then the act of screening
effects of the diseases which
.we were rvould have been rendeted futle.
trying to prevent in the ltst place' What is difficult to decide is when to
consider a treatment effective. A
Futthermote, although treating eatly tteatment is usuallY considered
disease may be cheapet and easiet, the effective if it has undetgone thorough
savings are often offset by the costs of evaluation 1n a randomlzed conttolled
having to do the scteening tests on large tnal. In such a trial, patients with the
numbets of aPPatentlY healthY disease in question a.re randomlv
indrviduals. For example, curative assigned to teceive either tl-ie new
sutgery fot a case of coronaqr attsty Lreatrnenl or a comparison Lreaunent
disease (CAD) may cost half a million (which can either be placebo or an oiC
pesosin the Philippines' In contrast, standard thetaPy). If such :- u.,r
pdmaty prevention of a single death shows that patients do better on the
from cardiovascular disease may entail new treatment, then it is generailY
tteating at least 143 patients fot high consideted effective. Such studies
cholesterol wrth a statin for 5 years't could support a tecommendation to
Depending on the statin used, this may screen fot disease. Flowevet, dre
cost as much as 20 mill-ion pesos. Indeed, study should show patients are doing
sometimes, pounds of Prevention
better not just biochemicallY
translate to just an ounce of cure.
(e.g.cholesterol is lower),
physiologicalln (e.g. blood ptessure is
Cdteria for Screening better), or anatomically (e.g' cotonaries
ate more o'ld"ly open). Doing bettet
Because health screening carries the should mean patients actually feel
better, ot live'longeg ftee ftom disease.
potential fc.,t harm, and because it can
lead to huge increments in unnecessary
public expenditures, critetia need to be 2. The burden of illness ftom the
set on when scteening fot eatly disease asymptomatic condition must have
should be done. Many such criteda have been measured accutatelY in
been developed, but most authors'''refet
locally-conducted communitY-
based studies.
to the ctiteria discussed belovz
OOOlSffiffi#F -i'.
Burden of illness refets to either Studies on the accuracy of
the prevalence of disease or its screening tests should be done in the
impact on people's lives. If a disease community-at-large because studies
is very rare, or if it is inconsequential, based in hospitals and clinics may
screening for it may not be a tend to exaggerate accuracy. This is
worthwhile exercise. Studies on because hospitalized patients tend to
burden of illness should be done in have more advanced illnesses which
the community-ar-large because are, therefore, easiet to detect.
studies based in hospitals or clinics
tend to include patients with severe 4. Cost effectivenessof thb screening
illness, and tend to exaggerate the tesq as well as treatment for the
true prevalence of the condition. disease, should have been
evaluated Iocally in properly
3. Accuracy of the screening test for conducted economic analyses.
the asymptomatic condition must
have been evaluated in validation Because effective screening tests
studies done in the community. must be performed on almost every
healthy person, cost becomes a major
All tests have two types of error concem. If economic resources were
tates that should be minimized unlimited, then people could have any
before they can be accepted as test done. Unfotunately, resorrce
screening tests. A false positive error constraints exist rn all countdes - with
refers to a positive test result in a no excepd.on - and are felt at different
patient who does not really have levels. At the public level, money spent
disease, while a false negative error on sceening could draw resources
refers to a negative test result in a away from other health concems such
patient who actually has the disease. as treatment for tuberculosis and
The hazards of false negative tests diarhea. At 'the household level
are easy to understand - patients will money spent by a househol& on
miss the chance for an early cure or screening could divert precious
treatment. The hazards of false resources from food, shelter and
positive tests, on the other hand, are education. Because- of this, for a
more difficult to appreciate. As screening test to be acceptable, its cost
pointed out eadieq telling patients (plus subsequent tfeatment for the
they have an illness (when they disease detected) should be
actually don't) can have physical and commensu{ate to the disease or
psychological effects that are far complication that it is being prevented.
more severe than the disase itself.
Furthermore. false positive resrs Studies that evaluate costs, dsks
often lead to a battery of expensive and benefits of treatment are called
and unnecesary follow-up economic analyses. Such studies qeed
ptocedutes. to be done locally because the costs of
I
I Inlroduclion and
Execuliue Summary
OOOOOC€*& ,,.
OOOt*&Wffi'q%-'+
ScreeningTests for Children
In sumrnarizing these extensive
sute Table E-t fot Childten - Screerung
^
rnade
d.liblruuott, the task forces by a tests that are tecommended
for the
was follovred
thut .u.h staterneflt seneralPo?ulatlon
as follows:
irr*^tY "f ?able'B'2 fot Children -
Evidence Scteerung
for selected
tests that are recommended
A) Burden of the Illness
B) AccuracY and ReliabilitY of the populatrons
Table B-3 fot Childten -
Scteerung
Test,
tests that cannot be recommended
C) AvailabilitY of Effective
being
Treatment for the illness 'i'"uir',s-+
routinelY
fot Children - Screqning
screened for, are aol recornmended
Issues and lests that
DJ Co.r.if..tilreness '
E,) R".o*-.,tdations of other
other
Scteening Tests for PregnantWomen
org".ri"rtiottt and -
iabl. b-t rot Ptegnant Womel ;
countlles' recommenoeo
Screening tests that are
an fo r the ge n ral PoPulation
e
oooulations
tests Table D-3 for adults' lmmuntzaflons
iJur" A-3 for Adults - Screening thatca n n o t b erecornmend
ed r o u ti n e 11
routine 11
n otberecornmend ed
lhatcan
teSts' Table D-4 for adults' Immunrzatrons
i"ir" A-4 fot Adults - Screening that cannot be recornmended
i^nl ar ea o/ rec ommende d'
nos
I E[,::R[.,:'"i::iffi tl:':::':ffixi
Firipr
ilil'ffi1;li"onhv
8
Introduction and
1 Executiue Summary
OOaS#ffiffiW#r.
Finally, it must be pointed out that
In summarizing recommendations
these r..ommendations have been
of the various task forces, the steetrng
of
.o-*i,r"" has taken the libertYfew drafted for aPPatentlY healthY
in a in<lividuals. Atl Task Forces have
*nt i.g minot modifications
that a thotough history and
,tut"-"".rt.. These changes dealt with "-."-"a
ohvsicll examination will precede the
,;t"i"g and periodiciry' and *ti:,Iil: i"orr"., for tests' Detection oI anY
tne
whcn necessary' in order to slmpllty
All the lir"ur" from the history and physical
recommendations' .*u*i"rA"" should warrant additional
,".o--"ndations, in their otiginal ,.rt. ^rra ate beYond the scoPe of the
?orrn, ,r" available in the individual
present guidelines'
chaPters.
*gtll"''I;,;[,iliil; I
Philippine Guidelines on Periodic q
Diseoses omong Apporenlly
Heoli
Eff ective Screenin!'for
Introduction and
1 Executiue Summarl
OOC##ffiffii's'E
tlr.at fie_c ommendedfotthe
TahleA-lfotMults' Scret E 60 yrs
20 -39 40 -49 50-59
-scnnnNtNc TESTS CONDITION
vts vfs vrs &qhove
Yearly Yearly Yearly
Ycariy
-.--ptt" r* n"dY Nless-[nJcx:
rn-
Wcight in kg /FIerght in
OR ObesitY
LIiP
ComPutc for Waist to
'Ratio:
'i)^i.t in-cm /
.ir.t*f"re'ce
c1n
I IiP circumfercncc 111
ffi
To
Exorninoiion:
I pnitioo]ne Guidelines on Periodic Heollh
t"1';l;;;t;;"g ipporenttv Heolthv Filipinos
10 | rtteciiue Screening
I Introdaction and
E,xeculiue Sunmary
OO*#ffiffiffidiirirr
ooc#ffiwffi
.fable A-2for Adults. Screening tests that u.. r""q-m"ttd"d fut s/:del fopfrdT
RISK FACTOR INTERVENTION
Chlamvdia infection
6[--rtoi" for leucocytes, or direct
Women < 25 who are
sexually active fluorcrccnt andgcn detection tests (DFA)
of cervical, urethral or pharyngeai fluid
specimens.
il
I Introduction and
Executiue Summary
oof sffi@ffi?i#b
Oral cancct
Familial Ankle brrchiel index (ABI) cvety 2 y ears Pelipheral Artcrial Disease
dy slipidemia
Phvsical Exam
OaOffiffiffiffi'#€i#i
:il
p
OOO&ffi@@t.lft: ',.
oot#ffi@@
are recommended
Table B-1for Children' Screening tests that
for the Senerdl Population
FREQUENCY CONDITIONS
POPUIATION INTERVENTION SCREENED
owth abnormalities
1. AII childr, (-ongenital adrcnal
2. Nconates 2 1 -hy droxylase defi cienq'
h.'ncrnlesia
r\s a Ncwborn Screen Ci6PD deficiencY
Flourescent sPot tcst
'fhyroid Stimulating
at 24 - 48 hrs of life Congenital
l..nothv roidisrn
IJormone
(lalactosemia
Clalactosemia tcst
Ycrrlv Visual disorder,
1. 2-5Yearsold Vison scrcenlng usrng
amblyopia or strabismus
Snellen chart or
stereoacuiw tcst 'lirhcrculosis
4 l-14 vears old
Deprcssion, anxietY
5. Adolcscent General Hcalth - Yearly
disorder & Pqrchosis
boys and girls Questionnaire
(10-19 vrs)
Ycerlv Domcstic violence
6. Adolescent Query for Past or Prcsent
grls (10-19 domestic violencc
vrs)
oos#ffiffi#+
Table B-3 for Children. Screening tests that cdnnot be recommended routinely
POPUIATION INTERVENTION CO\DINO\S
SCREL\iED
A,
1. Neonates N{easurement of phenylalamne Phel:-::e: :'-:: ?KL''l
level on a dried spot specimen
3. Infants at 6 months of
4. Older infants & Pre- Hearing screening ustng aucrlcr !{e:::: i=crce:
school childten (6 btainstem responses -r'BR . ,
OOO#.@ffiffiffi';i';ir,:'
Table C-l for Pregnant Women. Scteening tests that afe recommended
for the general populatioh
INTERVENTION FREQUENCY CONDITIONS
qCREENEr)
Ffis*nnr
T.asf Menstnra'l Period O,MP) At ieast once Measure sestational aEe
2. Tobacco or alcohol use or At least once Identifi high risk pregnarrcy
srrbsfance abuse
? Domestic ahrrse familv sfress At least once Identifv hieh risk Dresnancv
4. Environmental exposures at At least once Identi$' high risk pregnancy
home or at workolace
5. Ptevious poot pregnancy Once Identify high risk pregnancl
outcome, pretefm delivery,
fetal gtowth resttiction or
mal formation, placental
accidents, maternal
hemorhase
Pl1v inal F.vaminafion
t. Fundic height Every vrst Measure gestational age and
fetal orowth resttiction
2. Body Nlass Index @MI) Every visrt A ssess maternal nutrition
Weisht &E)/Heisht (m)
3. Fetal heart tones Every lrstt A ssess fetal comnromi se
I Intrariu;ftor -i,:;
E,xenri t : J ;,,,;,,;,; -.
aolfllt'
Table C-2 for Pregnant Vomen. Screening tests that are
recommended for selected populations
CO\DITION INTERVENTION FREQUENCY CONDITIONS
SCREENED
egular mcnses Date of first notc of fctal C)nce I,leasure gestational
herut tones
Quickening Once l.leasure gestational
age
Ultrasound C)nce \{easure gcstational
2ge
hlgh-rlsk tor HIV IIuman Ycarlr Human
infection whlqh Immunodefi ciencl- Viru s immunodcficiency
include the following:
ftIn) EI-ISA; if positive, \-irus (lII\r)
a. History of confirm usingWestern
injectable Rlot (WB),
substance abuse
immuno fluoresccnce
b. History of sex
assay (IFA) or
with multiple
partners
radioimmune
c. Partners of precipitation assay
persons with
multiple sex
partners
d. Commercial sex
workers, sexual
contacts of
persons with
sexually
transmitted
diseases (STD)
e. Persons exposed
Table c-4 for Pregnant women. Screening tests that ate not recommended
INTERVENTION (-r\N]T!TTTr\
I{outine ultrasound Fetal abnormalities
Routine Clinical Pelvimetrv
Itoutine fetal movement corrnfinq A ssess fetal well-bcins
Urinary dipstick PreeclamDsia
Groun B Streotococcal screenino Group B StreDtococcal (GBS) infection
Vagnal pH Bacterial Varinosis
R.ubella titers Sr ihilin' t^ P
"h.lt.
Gram stain and cultures for N. Gonorrhca Gonococcal infection
Gram stain for leucocytes, or dircct fluoresccnt Chlamydia infection
antigm detection tesrs Q)FA) ofcervical, urethral
or oharvnseal fluid snecimm*
Human Immunodcficiency Virus (FIT\I scree. l luman Inlmunodcfi cieno' Virus G{ IV) in fecti on
oos&@@ffi#
populations
Table D-2 for Adults' lmmunizations recommended fot selected
Influenza vaccination
ll H.t1,t*;orkers (i e physicians nurses' laboratory
'
I dose annuallY of
InlhLenza vacclnahon
tt"tgGrnes and contacts with residents or parenteral influenza
t-E "plq"*f
Datients vaccine
and ottrer testdcr'es [or
, [li.ri.t*t ",assisted lir rrrg tacilities
persons in high-ri'k groups' Li,,l,-r;cf groups*
i., high-nsk orn,r)s
t. i:il; -t;;;;;i;"';;;; ** .openc's in
I .0 url of duck embryo
Pre-exposure rables
ffi reserrch lchoratories (PDEV) or 0 5 ml Vero
vaccination
7. V.t.rinutiun md arimal handlers cell (PVRV) rabies vaccine
i tllitli'i"i;t;;,o-tJdi'"'tlv i"uolved in taking care ofrabid IM: or 0.I ml lD 1br both
0atients Npesonday0 7ald2lot'
o [,"ii*".f.* srrch as bill collcclors doot-to-doot sajes
)8: booster every 3 Years tl
Heorll" Exominoiion:
Philiooine Gurdelines on Period;c
for Diseoses omong ApporentlY HeolthY FiliPinos
22:l rfteciive Screening
I Introduclion and
Executiue Sammary
Oe€@@ffi&FPiiB
Table D-3 fot Adults. Immunizations that may or may not be recommended l
OOC#@Wffi'W-II;E '=,
Saunders, L996.
8. Lee PR. U.S. Department of Health
3. Hooper L, Battlett C, Davey Smith G, and FIuman Setvices, Ptess
Ebtahim S. Reduced dietaty salt fot Confetence, Report of the U.S.
ptevention of cardiovascular disease Pteventive Services Task Force,
(Cochrane Review). In The Cochrane 1996.
Library, Issue 2, 2003- Oxfotd:
Update Softwate 9. Canadian Task Force on Preventive
Health Qare. The Canadian Guide
4. Asano TI! Mcleod RS. Dietary fibte to CLinical Pteventive Health Care,
for the prevention of colorectal Ottawa, Canada.l'997.
adenomas and carcinomas (Cochrane
Review).. In: The Cochrane Library, 10 Audet AM, Gteenfield S, trield M.
Issue 2, 2003. Oxfotd: UPdate Medical ptactice guidelines; cutrenl
Software. activities and future directions. Ann
Intetn Med I99 0 ;1.1.3:7 09 -7 1, 4.
5. \7H.O. cooperative trial on primary
prevention of ischaemic heart disease 11. Fink A, I{osecoff J, Chassin M,
using clof,rbtate to lower se.rum Brook RH. Consensus methods:
cholesterol: mortality follow-uP. characteristics and guidelines for
Repott of the Committee of Principal use. Am J Public Health
Investigators. Lancet. 1 980. 1984;7 4:979-983.