Saudi Diploma in Family Medicine / 24 1 Dr. Zekeriya Aktürk Preventive Medicine and Periodic Health...

/ 241 Saudi Diploma in Family Medicine

Dr. Zekeriya Aktürk

Preventive Medicine and Preventive Medicine and Periodic Health Examinations in Primary CarePeriodic Health Examinations in Primary Care


Aim-Objectives

• At the end of this presentation the participants will be;– Able to describe the role of PHE in primary care

– Able to count three diseases with highest mortality

– Able to define PHE

– Able to explain the effective screening criteria used in PHE

– Aware of the risks in PHE

– Able to describe current clinical preventive service recommendations for family practice

– Aware of the importance of PHE and preventive medicine in primary care.


What are primary care physicians doing?Health Care

Health promotion

Risk prevention

Early diagnosis

Complication reduction

Risk reduction

Personal Preventive Medicine!

Primary Prevention Secondary PreventionTertiary

Prevention


Prevention of what?


Reasons of diseases (%)

0

5

10

15

20

25

30

35

40

45

50

Access Genetic Environment Behaviour


Insurance companies:“Mortality decreases in persons undergoing regular health checks!”

CHECK-UP(1921)

PERIODIC HEALTH EXAM was introduced.(1970)

Some diseases don’t have enough clues at the beginning, and when able to diagnose there was no time for treatment: check-up

gone. Changing by personal factors such as age, exposure, sex, and risk


Definition

Evaluation of apparently health individuals in certain time periods, using a number of standard procedures such as counseling, physical examination, immunization, and laboratory investigations is called Periodic Health Examination.


Does it work?

• USA: Mortality from stroke has decreased by 50% since 1972– Early diagnosis and treatment of hypertension

• Mortality from cervix cancer decreased by 80%• Neonatal screening

– Decrease in mental retardation• Phenylketonuria screening• Congenital hypothyroidism

National Center for Health Statistics. http://www.cdc.gov/nchs/r&d/ndi/ndi.htm


Immunization and Polio• Polio eradication in Turkey • Every year 6.5 million children are immunized• Last case seen in 1998

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

1971

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

Morbidite hızı(1/100.000)

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

Mortalite hızı(1/1.000.000)

Turkish MoH, polio morbidity and mortality rates. http://www.saglik.gov.tr/extras/istatistikler/temel2000/97.htm


Think of your daily life

• A 30-year old woman applies to your office. She has no history of disease but afraid of becoming breast cancer. – Should you perform a breast exam?

– Should you teach her breast self exam?

– Should you order a mammography?

• How do you decide?


1. Prevalence of the disease should be highNo sense to screen diseases with low prevalance.

- Osteogenesis imperfecta: incidence 1/10 000/year

Effective screening criteria

Medline Plus. Medical Encyclopedia. Osteogenesis imperfecta. http://www.nlm.nih.gov/medlineplus/ency/article/001573.htm


2. Predictive risk factors or tests should be presentThe safety and cost of the test should be known

- CRP: Cheap but not specific - Echocardiograpy: sensitive and specific but expensive



10 4

6 80

Diseased (Prevalence)

Healthy Specifity

Sensitivity

PPV NPV

(+) Test (-) Test

Basic ParametersPopulation-100 persons


3. Morbidity and mortality should be highFactors related with morbidity and mortality (beyond the disease itself) :


- Age- Sex- Race- Gegraphical area- Life style (culture)



• 0-18 months• Perinatal causes• Congenital anomalies

• 7-12 years• Accidents other than motor vehicle • Motor vehicle accidents

• 19-39 years• Motor vehicle accidents• Suicide

• 65 years and older• Heart diseases• Cerebrovascular diseases

Mortality according to age groups


4. There should be an acceptable treatmentNo sense to srean untreatable diseases- Lung cancer (?)

5. There should be a prodromal period without complains- AIDS- Syphilis- Cervix cancer- Breast cancer



4 year

Beginning

Beginning

Symptoms

Symptoms

DEATH

DEATH2 year

1 year6 mo

Aggressive cancer

The same cancer but less aggressive

Screening once a year

The natural course of diseases


Let’s come back to our example: patient with breast cancer

• It’s an important disease for women– Worldwide 719000 new cases/year. (1/1000)

• Morbidity/mortality• It can be recognized without symptoms

– Mammography

• Curable– Surgery, Chemotherapy, Radiotherapy

• The value of treatment is more than its adverse effects


Can periodic health examination be harmful?Asymptomatic

person

Screening

Test normal Test abnormal

True negative False negative

Reassurance Delay in diagnosis

True positive False positive

AnxietyTreatment

The average error rate of a test: %5

Ian R. McWhinney. A Textbook of Family Medicine. Oxford University Press, USA 1997.


• Chest x-ray to screen lung diseases,

• Urinanalysis to screen urinary diseases,

• ECG,

• Microfilm to screen Tbc,

• PSA to screen prostate cancer,

• Self exam to screen breast cancer,

• CBC,

• Influenza immunization for healthy adolescents

The Check-up Chaos


How is PHE performed?

• Healthy individuals• Counseling

• Immunization

• Home visit

• Prophylaxis

• Physical exam

• Laboratory test


Any Guidelines for KSA?


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Saudi Diploma in Family Medicine / 24 1 Dr. Zekeriya Aktürk Preventive Medicine and Periodic Health...

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