Periodic Health Examination | Screening (Medicine) | Hypertension

Evidence-Based Periodic Health Examination

☻ Bagian Ilmu Kesehatan Masyarakat (IKM) ☻ Bag. Epidemiology Fakultas Kedokteran Umum UMY

dr. Titiek Hidayati M. Kes.

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• Pemeriksaan kesehatan berkala yang berdasarkan pada bukti – bukti kesehatan (Evidence Based) • Tentang berbagai tes kesehatan yang tepat guna sesuai waktu dan kegunaannya
• Task Forces on Prevention • Health Screening as a Strategy for Preventive Medicine
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Periodic health examination (PHE)
• Periodically, patients visit physicians’ office not because they are unwell, but because they want a ‘check-up’. Such visits are referred to as health maintenance or the PHE. The PHE is an opportunity to relate to an asymptomatic patient for the purpose of case finding and screening for undetected disease and risky behavior. It is also an opportunity for health promotion and disease prevention. The decision to include or exclude a medical condition in the PHE should be based on the burden of suffering caused by the condition, the quality of the screening, and effectiveness of the intervention.
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Pencegahan lebih baik dari pada pengobatan An ounce of Prevention equals to pounds of Cure .

Dinkes propinsi dan Depkes) . Dinkes kabupaten.Task Forces on Prevention ■ The US Preventive Services Task Force (1984. 1996. Sie P2M dan PTM (Puskesmas.Sie Promosi kesehatan. 2002) ■ The Canadian Task Force on Periodic Health Examination (1997) ■ The Task Force on Philippine Guidelines Periodic Health Examination (2004) .

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2004) Health Screening as a Strategy for Preventive Medicine . Health Screening (doing tests for early detection of disease or risk factors for disease) 2.(Task Force on Philippines Guidelines on PHEX. health care has seen a major shift in philosophy from curative medicine to preventive medicine Four major strategies used in the rapidly growing field of Preventive Medicine: 1. In the last half century. Risk factor control (treatment of factors that predispose to disease) 4. Vaccination programs (immunization against infectious diseases) . Lifestyle change (avoidance of unhealthy habits) 3.

timely prevention Screening (WHO. 1994): Penggunaan metode-metode yang dianggap bisa mendeteksi risiko kesehatan yang tidak dikenal atau penyakit yang asimptomatik pada individu-individu yang tampak sehat dalam rangka membolehkan dilakukannya pencegahan atau pencegahan yang tepat pada waktunya . 1994): The use of presumptive methods to detect unrecognized health risks or asymptomatic disease in apparently healthy individuals in order to permit prevention & .Screening (WHO.

Screening (executive medical check up) is performed to categorize members of the general public into: Higher probability of disease This group is urged to seek further medical attention for definitive diagnosis & treatment Lower probability of disease ..

Lifestyle changes such as salt restriction: have failed to lead to appreciable changes in the incidence of stroke & coronary disease in the general population Most dietary maneuvers. like high fiber diet. and in some instances has even led to an increase in deaths: The cholesterol lowering drug clofibrate. was removed from the market because a trial by WHO showed more deaths among patients who received treatment .Pitfalls of Screening & Other Preventive Medicine Strategies: Things that ought to work do not always so . have not been proven effective in cancer prevention Risk factor control has failed as well.

Many screening tests. the side effects of screening have been far worse than the effects of the diseases which we were trying to prevent in the first place . physical & even financial stability of unfortunate individuals Productive people have been denied insurance or employment or have resigned from work because of depression Many times. many asymptomatic patients are wrongly labeled as being “ill” (false labeling) Instead of improving the quality of life of people. Consequently. psychological. false labeling has been found to wreak havoc on the social. such as ECG: have been found to be inaccurate for detection of early coronary disease .

primary prevention of a single death from cardiovascular disease may entail treating at least 143 patients For high cholesterol with a statin for 5 years. this may costs as much as 20 million pesos (Rp 4 milyar) Indeed. sometimes.. “pounds of prevention” translates to just “an ounce of cure” . Although treating early disease may be cheaper & easier. depending on the statin used . the savings are often offset by the costs of having to do the screening tests on large numbers of apparently healthy individuals Curative surgery for a case of coronary artery disease (CAD) may cost half a million pesos (Rp 100juta) in the Philippines In contrast.

Criteria for the use of screening test (Blueprints Family medice. Lipsky) • Criteria for the use of screening tests include the following : .Characteristics that measure the accuracy of screening tests include sensitivity. comfort and complications . speciticity.Effective treatments for the disease are available . positive and negative predictive values 17 .The screening tests or procedures are accurate and reasonable in terms of cost.The disease is common and significantly affects individuals and society . Martin S.

(Task Force on Philippines Guidelines on PHEX. Because health screening carries the potential for harm & because it can lead to huge increments. 2004) Criteria for Screening . criteria need to be set on when screening for early disease should be done Four criteria .

The burden of illness from asymptomatic condition must have 3. risks & benefits of treatment) . Accuracy of the screening test for the asymptomatic been measured accurately in locally-conducted community-based studies (disease prevalence or its impact on people’s lives) condition must have been evaluated in validation studies done in the community (false positive & false negative errors) 4.1. Cost-effectiveness of the screening test. as well as treatment for the disease. should have been evaluated locally in properly conducted economic analysis (studies that evaluate costs. Treatment for the asymptomatic condition must have been evaluated using well-designed randomized controlled trials (RCTs) that observed effects on clinical outcomes . 2.

• Communitybased VS Studies Hospitalbased Studies: Hospitalized patients tend to have more advanced illness (easier to detect): Exaggerate the prevalence of the condition .

2. but not all no. Level 1: Recommendation satisfies all the above criteria Level 2: Recommendation satisfies no.1 Level 4: Recommendation satisfies none of the criteria .2.3 & no. 1. 2004) Recommendation Scale . no.4 Level 3: Recommendation satisfies no.4.(Task Force on Philippines Guidelines on PHEX.3 & no. no. but not no.

2004) Executive Summary of Various Screening Recommendation . Screening Tests for Adults: Table A-1 for Adults: Screening tests recommended for the general population Table A-2 for Adults: Screening tests recommended for selected populations Table A-3 for Adults: Screening tests cannot be recommended routinely Table A-4 for Adults: Screening tests not recommended .(Task Force on Philippines Guidelines on PHEX.

Screening Tests for Children: Table B-1 for Children: . Screening tests recommended for the general population Table B-2 for Children: Screening tests recommended for selected populations Table B-3 for Children: Screening tests cannot be recommended routinely Table B-4 for Children: Screening tests not recommended .

Screening Tests for Pregnant Women: Table C-1 for Pregnant Women: Screening tests recommended for the general population Table C-2 for Pregnant Women: Screening tests recommended for selected populations Table C-3 for Pregnant Women: Screening tests cannot be recommended routinely Table C-4 for Pregnant Women: Screening tests not recommended . .

Immunizations for Adults: Table D-1 for Adults: . Immunizations recommended for the general population Table D-2 for Adults: Immunizations recommended for selected populations Table D-3 for Adults: Immunizations cannot be recommended routinely Table D-4 for Adults: Immunizations not recommended .

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Martin S.Preventive care (Blueprints Family medice. In the secondary prevention to prevent or limit future disease is important. • The most common causes of death in adults aged 19 to 40 years are accident. 28 . The consequences of Ht may not be seen for years after a person develops high blood pressure. So. • Screening for cardiovasculer risk factors and malignancy become a focus of health care visits for individuals over age 40. • Ht is a significant risk factor for heart disease and stroke. homicides and suicides. BP evaluation & tx is preventive measure for future disease that may not manifest itself until the patient is 70 years of age or beyond. reflecting the changes in disease prevalance across the adult life span. Lipsky) • The focus of preventive care is age-dependent.

Availability of the Effective Treatment for the illness being screened for 4. Accuracy & Reliability of the Test 3. Burden of the Illness 2.. Each recommendation statement was followed by a Summary of Evidence as follows: 1. Recommendations of other organizations & other countries . Cost-effectiveness issues 5.

The auscultatory method using a mercury sphygmomanometer is recommended for the diagnosis of hypertension as well as for the monitoring of blood pressure (level 2) 3.(Task Force on Philippines Guidelines on PHEX. Ambulatory blood pressure monitoring is not recommended for screening (level 2) . Recommendations: 1. 2004) Screening for Hypertension . Screening for hypertension is recommended (level 2) 2.

2004) Screening for Dyslipidemia . Recommendations: 1. Screening for dyslipidemia using a non-fasting total cholesterol level alone should be done in individuals aged 40 or above with no other risk factors (level 2) 2. Screening for dyslipidemia using a complete lipid profile [Total Cholesterol. Patients with evidence of familial dyslipidemia (xanthoma. High Density Cholesterol (HDL) & Triglycerides) should be done in: a. obese. family history of early cardiovascular disease) (level 2) . Low Density Lipoprotein (LDL). Patients with two or more of the following risk factors (smoker. post-menauposal) b.(Task Force on Philippines Guidelines on PHEX.

obese.Recommendations: 1. and above.(Task Force on Philippines Guidelines on PHEX.o. Mass screening for DM using fasting plasma glucose (FPG) levels or the oral glucose tolerance test (OGTT) is not recommended (level 2) . patients with evidence of familial dyslipidemia & those with history of delivery of babies large for gestatitional age (level 2) 2. smokers. Selective screening using fasting plasma glucose is recommended for high-risk individuals (patients 40 y. patients. with a family history of DM. 2004) Screening for Diabetes .

Recommendations: Screening for obesity using the waist-to-hip ratio (WHR) or body mass index (BMI) is recommended for apparently healthy individuals (level 3) . 2004) Screening for Obesity .(Task Force on Philippines Guidelines on PHEX.

The US Preventive Services Task Force Recommendations covers: . Various age groups: ● Birth to 10 years ● Ages 11 to 24 years ● Ages 25 to 64 years ● Ages 65 years and older 2. 1. Four aspects: ● Screening ● Counseling ● Immunizations ● Chemoprophylaxis .

(Task Force on Philippines Guidelines on PHEX.Recommendations: Screening with regard to sedentary lifestyle is recommended (Level 4) . 2004) Screening for Sedentary Lifestyle .

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Burden of Illnesses (Morbidity & Mortality) in Indonesia & the World 2. 1. Perilaku Hidup Bersih & Sehat (PHBS) 3.Assignments . PHE in the US from Rakel .

Terima kasih .

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