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