Due to rapid growth of medical knowledge and widening application of technology to medicine, there is a particular need for a continuing authoritative review of standards for both preventive and therapeutic strategies. Some of these strategies come under the general category of periodic health examination. Check-up examinations, referred to as periodic health examination (PHE) or an annual physical examination has two main goals i.e., prevention of specific disease and the promotion of health. It has been widely promoted for early detection of diseases and illnesses.
Periodic Health Examination (PHE):
The periodic health examination is a group of tasks designed either to determine the risk of subsequent disease or to identify disease in its early symptomless state. It covers simple interventions, such as injections and recommendations for the prevention of disease or the maintenance of health.
In order, to assess patients overall health and risk factors for preventable diseases the PHE consists of one or more visits with a health care provider. It is distinguished from the complete physical examination by integration of tailored clinical preventive services and laboratory testing as part of health risk assessment. In addition, to a physical exam the health care providers perform a history and risk assessment, on the basis of which the information gathered by providers, patients may receive counseling, immunizations, lab testing or arrangements for other preventive health services as part of the evaluation. Two of the most evidence based guidelines for periodic health examination were published by US preventive services task force and Canadian task force.
In the 1920s the American Medical Association first proposed a yearly, routine physical examination for healthy patients. In 1976, the Canadian Task Force on the periodic health examination now known as Canadian Task Force on Preventive Health Care (CTF) was established to provide a systematic evaluation and recommendations about periodic health exams. The United States Preventive Services Task Force (USPSTF) was formed in 1984 to provide similar guidelines in the United States. The most recent recommendations of the USPSTF for evaluation, screening and counseling interventions were published in 1996. These recommendations were based on available evidence of safety and efficacy and are modified for patients based upon their individual age, gender and risk factors for disease.
Framework of Periodic Health Examination:
The framework of periodic health examination involves:
a) Goals and expectations of patient, provider and society are to:
- Promote patient and family health
- Detect early, subtle symptoms, asymptomatic illness
- Prevent patient morbidity and mortality
- Educate patients about problems for which they are at risk
- Educate patients regarding the appropriate utilization of the health care system
- Facilitate patient-health professional relationship
- Facilitate patient-health care organization relationship
- Identify opportunities for early intervention in disease
- Improve public health
b) System-based interventions:
A system-based intervention improves the delivery of PHE by setting up of appointment for the PHE and offering a free PHE.
c) Modifiers of PHE effect:
A PHE delivered at different patient ages or different frequencies, is related with benefits like:
Clinical preventive services:
The PHE consistently improved the delivery/receipt of the gynecological examination/Pap smear, cholesterol screening and fecal occult blood testing. The strength and consistency for these outcomes ranged from medium (cholesterol screening) to high (gynecological examination/Pap smear and fecal occult blood testing). The studies assessing the delivery/receipt of preventive counseling, immunizations and mammography were mixed among the effects of the PHE and its outcomes ranged from low (mammography and counseling) to medium (immunizations).
Proximal clinical outcomes:
The PHE had mixed effects on disease detection, health habits, blood pressure, serum cholesterol and BMI. The strength and consistency for these outcomes ranged from low (serum cholesterol) to medium (disease detection, health habits, health status, blood pressure and BMI).
Distal clinical and economic outcomes:
The PHE had mixed effects on costs, disability, hospitalization and mortality. The strength and consistency ranged from medium (costs, disability and mortality) to high (hospitalization).
Other benefits of PHE from patient, provider and society perspective involve:
- Knowledge Guidelines system use
- Change in expectations
- Change in health habits (e.g. smoking)
- Motivation to improve habits (e.g. stage of change)
- Proximal (e.g. blood pressure control)
- Distal (e.g. cardiovascular events, death)
Resource use and costs:
- Ambulatory visits
- Emergency department use
- Family health
- Community health
- Communicable disease containment
So, the need for periodic health examination is to evaluate health status, screen for risk factors and disease, provide preventive counseling interventions in an age-appropriate manner.
Example of Periodic Health Examination:
Women and Men aged 16-44:
– Tetanus and diphtheria
– Travel related
– CA cervix
Thus, the periodic health examination is the vital part of health care and clinicians will be able to improve the effectiveness of the PHE by improved methods of detecting and preventing disease, risk factors for disease and reducing morbidity and mortality from illness.
Guest Author: Ruby Bhullar
Student: James Lind Institute
The above article has been submitted by a guest author. CRS is not responsible for any information provided in this article.