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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

Pre-clinical phase Clinical phase

outcome

symptoms diagnosis therap
Biological y
Lead time
onset of
disease Detectable
by
screening
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 TEST
1.Should be sensitive and specific
2.Simple and cheap
3.Safe and acceptable
4.Reliable
5.

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
here's the format
for your ASSIGNMENT...
WELLNESS PLAN REPORT :
personal and family
I. 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
VI.
DO YOUR
SELF INVENTORY
and prepare a
wellness plan
for yourself &
Your family