BRIEFER ON PERIODIC HEALTH EXAMINATIONS

THE PERIODIC HEALTH EXAMINATION

Periodic Health Examination (PHE) became generally accepted in the early 1900s
after the American Medical Association officially endorsed PHE and began a
campaign to spread its practice. In the late 1960s, people started to test and
examine the value of screening. The World Health Organization commissioned a
comprehensive review of screening worldwide which created ten criteria 1 to be
applied before considering screening for a particular disease, specifically:
1. The condition sought should be an important health problem
2. There should be an accepted treatment for patients with recognized
disease
3. Facilities for diagnosis and treatment should be available
4. There should be recognizable latent and early symptomatic stage
5. There should be suitable test or examination
6. The test should be acceptable to the population
7. The natural history of the condition including development from latent to
declared disease should be adequately understood
8. There should be agreed policy on whom to treat
9. The cost of case finding (including diagnostics and treatment of patients
diagnosed) should be economically balanced in relation to possible
expenditure on medical care as a whole
10.Case-finding should be a continuing process and not a once for all project
Opinions regarding use of PHE have shifted over the years and medical
professionals now view them with skepticism 2. Critical analysis show little evidence
of its value other than belief with increased health care utilization and costs 3. A
systematic review2 of PHE in 2007 was unable to show improvement in outcomes in
any improvements studies but tend to lessen patient worry, although there are
some issues regarding methods. While potential benefits of the health screening are
easy to understand, there are possible physical and psychological harms for
indiscriminate testing. Over-diagnosis, overtreatment and health anxiety are viewed
to be common outcomes if health screening recommendations are not evidence
based.
A local study4 from UP Manila in 2011 echo the same sentiments and recommend
that criteria for health screening should include (1) high burden of illness, (2)
accurate screening and confirmatory tests, (3) more effective early treatment or
prevention rather than late treatment, (4) safe test, and (5) commensurate cost of
screening strategy to potential benefit.
Despite changes in recommendations, the continued implementation of PHE may
reflect influence of patient over provider expectations regarding the use of PHE in
clinical practice. According to a study 5, over 90% of patients desired examinations in
excess of CFT guidelines, most often on an annual basis.
SOURCES OF RECOMMENDATIONS

At present, our common sources for screening recommendations are Clinical

Practice Guidelines, World Health Organization or the Department of Health. These
recommendations are dynamic and are often updated based on most current
evidence.
But when applied at a national scale, health screening recommendations must
undergo further cost-effectiveness analysis before being applied to policy. This is
also the rationale behind the Disease Control Priorities Project (DCCP) wherein their
results also considered economic constraints and implementation issues. The
growth in number of economic evaluations of health interventions has created a
wider knowledge base for evaluation the costs and benefits of interventions to
enable better targeting of financial resources in the health sector 6.
EVIDENCE ON SOME TESTS IN THE PERIODIC HEALTH EXAMINATION
A recent study7 on NHS Health Checks showed that there was no significant
difference in the change of prevalence of diabetes, hypertension, coronary heart
disease, chronic kidney disease, and atrial fibrillation in practices providing NHS
Health Checks compared with control practices.
Another study8 on routine chest radiography showed low diagnostic yield in
asymptomatic primary care patients with total direct diagnostic cost of up to
$46,609 in one primary care clinic. This is consistent with findings from a Mayo
Clinic9 study wherein there is also no benefit in screening smokers for lung cancer
during radiography. And even if with findings, another study 10 showed that a cancer
1 cm in diameter may be associated with the same prognosis as a lesion three
times as large wherein symptoms are often already present.
Another Mayo Clinic study11 showed around 36% initial abnormal result on
frequently obtained laboratory tests during a periodic health examination, but after
further investigations found low diagnostic (4.8%) and therapeutic (4.0%) yields.
Therapeutic yield for each case-finding was as follows: lipid profile 16.5%, chemistry
panel 2.8%, complete blood count 0.9%, urinalysis 0.8%, and thyroid tests 0.7%.
BENEFIT SCOPING FOR TSEKAP 2015
The current TSEKAP Package was designed using the following criteria:
1. Epidemiologic fit addresses top medical conditions that place heaviest
burden on the population, reflecting conditions of the poorest and most
vulnerable in the population
2. Efficiency prioritizes interventions that are low cost but effective (highly
cost-effective) and interventions that will avert unnecessary hospitalizations
3. Feasibly delivered at primary care level 0 contains interventions that can be
effectively and feasibly delivered at the primary care level
4. Entire cycle of care aims to cover diseases where it can fund the cycle from
screening, diagnosis, treatment and rehabilitation to ensure achievement of
health outcomes

BIBLIOGRAPHY
Wilson, HMG et al. Principles and Practice of Screening for Disease. Genera: World Health
Organization, 1968.
2
Holland, W. Periodic health examination: history and critical assessment. London School of Economics
and Political Science. EuroHealth 2009 Volume 15 No 4.
3
Boulware EL et al. Systematic review: the value of the periodic health evaluation. Annals of Internal
Medicine 2007; volume 146, pp289-300
4
Dans, L. et al. Trade-off between benefit and harm is crucial in health screening recommendations.
Part I: General principles. Journal of Clinical Epidemiology volume 64 issue 3. University of the
Philippines Manila. pp 231-239
5
Romm, F. Patients expectation of periodic health examinations. Journal of Family Practice 1984;
19(2): 191-5.
6
Laxminarayan, R. et al. Chapter 2: Intervention Cost Effectiveness. Disease Control Priorities in
Developing Countries 2nd Edition. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK11784/
7
Caley, M. The impact of NHS Health Checks on the prevalence disease in general practices: a
controlled study. British Journal of General Practice. 2014
8
Tigges, S, et al. Routine Chest Radiography in a Primary Care Setting. Radiology 2004. Radiological
Society of North America. pp 575-578
9
Fontana RS et al. Lung Cancer Screening: the Mayo Clinic Program. Journal of Occupations Medicine
1986. 28: 746-750.
10
Shah, PK et al. Missed non-small cell lung cancer: radiographic findings of potentially resectable
lesions evident only in retrospect. Radiology 2003; 226:235-241.
11
Boland, B et al. Yield of laboratory tests for case-finding in the ambulatory general medical
examination. The American Journal of Medicine volume 101 issue 2, 1996, pp 142-152