PERIODIC HEALTH EXAMINATION

DR PATRICIA ESEIGBE MBBS, MPH (LIVERPOOL), FWACP

LECTURER/CONSULTANT

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DEPARTMENT OF FAMILY MEDICINE

BINGHAM UNIVERSITY/BINGHAM UNIVERSITY TEACHING HOSPITAL, JOS.

FEBRUARY 2024.

OUTLINE

OBJECTIVES

INTRODUCTION

• Periodic Health Examination (PHE) dates to centuries ago, the industrial revolution, when employers paid for annual check-ups to maintain a healthy labour force of their employees.
• Presently, PHE is mainly done by Family Physicians in most places.
• PHE can also be referred to as Periodic Health Visit, Health Maintenance Visit
• PHE is the evaluation of an individual’s health status, screening for risk factors and disease, and providing preventive counselling in an age-gender-appropriate manner.

INTRODUCTION -2

• PHE is based on age, gender, and risk-factor characteristics.
• It involves detailed history taking and a full physical examination.
• It aims to prevent disease and halt the progression of an existing disease
• It also serves as a medium to educate clients about lifestyle issues, behavioural patterns or risky environmental exposures, and vaccination updates.
• It helps to identify risk factors for disorders and diagnoses of diseases.
• PHE provides the opportunity to do evidence-based preventive care, that is, Primary, Secondary, and Tertiary prevention.

INTRODUCTION -3

• PHE may serve as a mechanism to assist marginalized groups who would otherwise not regularly go for periodic checks.
• It may also facilitate efforts surrounding the management of chronic diseases.
• PHE fosters a doctor-patient relationship, which has been shown to affect health outcomes.
• Another goal of PHE is to help individuals live healthier and longer lives!

INTRODUCTION -4

• PHE may not necessarily be done annually in clients at low risk.
• Some Western countries recommend that otherwise healthy adults aged 40 – 75 years do PHE, stating that this age group has an increasing burden of chronic diseases that may be amenable to intervention.
• Though some systematic reviews have reported no significant impact of PHE on patient outcomes.
• PHE may result in many investigations, such as blood and radiological tests, exposing clients to the risks of the tests and the risks of false-positive results, including overdiagnosis.

PHE FOR YOUNG ADULT

• There is a high certainty that the net benefit of these recommended services is substantial.
• These PHE services should be offered or provided to clients.
• They are mainly from;
• The United States Preventive Service Task Force (USPSTF)
• Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)
• American Cancer Society (ACS)
• American College of Obstetrics and Gynaecology (ACOG)

PHE FOR YOUNG ADULT -2

A Young Adult is between the ages of 18 and 39 years.

The recommended PHE for a young adult includes;

• Screen for Hypertension – Using the JNC recommendations, should be done every 2 years if BP is less than 120/80, and every year if SBP is 120-139 and DBP of 80-90.
• Screen for Hyperlipidaemia – LDL, HDL, Total Cholesterol
• Breast cancer screen – Self Breast Examination (SBE), Clinical Breast Examination (CBE), and Mammography. BRCA mutation testing for breast and ovarian cancers targeted clients at increased risk.

PHE FOR YOUNG ADULT -3

• Cervical cancer screen – Pap smear, HPV test, and Colposcopy. Should be commenced at age 21 years if has had sexual debut. Done every 2-3 years.
• Screen for Chlamydia infection, if sexually active
• HIV screen, check for risk factors and offer preventive care
• Check for Rubella susceptibility by a history of vaccination and serology
• Offer Contraception to prevent unintended pregnancy
• Assess for Depression

PHE FOR YOUNG ADULT -4

• Obesity screen – BMI, Waist-hip-ratio, Waist circumference
• Screen for Alcohol Use Disorders – Using AUDIT, CAGE
• Screen for Tobacco use and counsel as needed – Behavioural counselling, Pharmacotherapy, Use the Five ‘As’, including

1. Ask about tobacco use 2. Advice to quit

3. Assess willingness to quit 4. Assist to quit

5. Arrange for follow-up visits and support

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PHE FOR MIDDLE-AGED

Clients between 40 and 49 years

• Should be screened for Lipid disorders if they are at increased risk for Coronary Heart Disease (CHD). Risk factors such as Diabetes mellitus, hypertension, obesity, tobacco use, previous history of CHD or noncoronary atherosclerosis, and family history of CVD.
• Screen for Type 2 Diabetes mellitus
• Include the screening services listed for the Young Adult.

PHE FOR MIDDLE-AGED -2

Clients between the ages of 50 and 59 years

• Colorectal cancer screen – A. Annual high-sensitivity faecal occult blood B. Sigmoidoscopy every 5 years and the above A. every 3 years C. Screening Colonoscopy at intervals of 10 years.
• Prostate cancer screen – Digital Rectal Examination (DRE) and Prostate Specific Antigen (PSA) analysis
• Aspirin chemoprevention – weigh benefits and risk
• Include the other screening.

PHE FOR ELDERLY

Clients aged 60 to 74 years

• Screen for Abdominal Aortic Aneurysm (AAA) using ultrasonography – should be done in men. Women have a lower prevalence and high false-positive rates.
• Screen for Osteoporosis in postmenopausal women every 3 years, using the Osteoporosis Risk Assessment Instrument
• Include other screening.

PHE FOR ELDERLY -2

Clients > 75 years

• The PHE for the aged is complex!
• It is essential to work with them to make informed and individualized health maintenance decisions.
• They have wide variations in the number and severity of comorbid conditions, their functional status vary, with different life expectancy, and peculiar patients’ overall goals of care and preferences.
• Nutritional screening and counselling are essential . Lifestyle screen
• Dementia screen .Visual and hearing impairment screen.

IMMUNIZATIONS IN PHE

• Human Papilloma Virus (HPV) vaccine
• Varicella and Zoster vaccines
• Measles, Mumps, Rubella (MMR) vaccine
• Hepatitis B vaccine and Hepatitis A vaccine
• Pneumococcal and Influenza vaccines
• Meningococcal vaccine.

CONCLUSION

BIBLIOGRAPHY