Screening Introduction to Primary Care: a course of the Center of Post Graduate Studies in FM PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847

Objectives Describe the role of Periodic Health Examination (PHE) in primary care Count three diseases with highest mortality Mention PHE guideline resources Explain the effective screening criteria used in PHE Aware of the risks in PHE Aware of the importance of PHE and preventive medicine in primary care.

wrongly diagnosed disease Iceberg phenomenon ? 1 Diseased, diagnosed & controlled 2 Diagnosed, uncontrolled 3 Undiagnosed or wrongly diagnosed disease 4 Risk factors for disease 5 Free of risk factors Diagnosed disease Undiagnosed or wrongly diagnosed disease

The High mortality diseases in Saudi Arabia Symptoms /Signs ill defined …… 24.64% Diseases of CVS………………... 21.82% Injury / Poisoning………………. 18.31% Conditions perinatal period…….. 9.88% Neoplasms……………………… 4.55% Diseases of RS…………………. 4.38% MOH- Saudi Arabia

Evidence Based Recommendations

Screening Screening involves the utilization of a diagnostic procedure to check for the presence of a disease prior to the manifestation of clinical symptoms

Goal of screening The goal of screening and evaluation is to prevent the onset of disease or the worsening of an existing disease. For example, measurement of blood pressure is intended to detect hypertension so as to initiate treatment and prevent subsequent morbidity (e.g., stroke or renal failure) or mortality.

World Health Organization — Principles of Screening The Wilson-Jungner Criteria. Public Health Paper 1968, Geneva, WHO The condition should be an important health problem. There should be a treatment for the condition. Facilities for diagnosis and treatment should be available. There should be a latent stage of the disease.

There should be a test or examination for the condition. The test should be acceptable to the population. The natural history of the disease should be adequately understood. There should be an agreed policy on who to treat. The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole. Case-finding should be a continuous process, not just a "once and for all" project.

Types of screening Mass Targeted Multiple or Multiphasic Case-finding or opportunistic

Risk in Screening Adverse effects of screening procedure (e.g. Stress, anxiety, radiation exposure, chemical exposure). Stress and anxiety caused by a “False Positive” screening result. Unnecessary investigation and treatment of false positive results.

Prolonging knowledge of an illness if nothing can be done about it. A false sense of security caused by false negatives, which may even delay final diagnosis. Overuse/waste of medical resources. Unnecessary and uncomfortable procedures looking for a disease that is unlikely

Periodic Health Examination The purpose of the periodic health examination is to evaluate health status, screen for risk factors and disease, and provide preventive counseling interventions in an age-appropriate manner

Importance of PHE Educate patients about behavioral patterns or environmental exposures that pose risks for future diseases. Examples include counseling about smoking prevention and cessation to prevent lung cancer and emphysema, seat belt use to prevent motor-vehicle injuries, or modifying sexual practices to prevent the spread of sexually transmitted disease.

Sources for information of PHE AAFP recommended periodic-health-examinationwww.aafp.org/fpr/970300fr/5.html Canadian Task Force on Preventive medicine.www.ctfphc.org NHS Screening. www.screening.nhs.uk PHE.www.answers.com/topic/periodic-health-examination PHE. www.enotes.com/public-health-encyclopedia/periodic-health-examination

Screening / PHE programs in Saudi Arabia Annual periodic health examination for all diabetic and hypertensive patients registered at PHC Cervical screening Breast cancer screening in some areas Pre-marital screening (genetic dis., infectious dis.) Well baby clinic

Counseling Counseling during the periodic health examination is also very important, for this is where physicians recommend changes in lifestyle that can affect future morbidity and mortality Premarital Risky behaviours Smoking According to age group Healthy diet Exercise...

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