Evidence-based health maintenance protocols (screening) Family medicine department, Suez canal university, Egypt

1. Dr. Basma Mohamed abd el aziz
FM , SCU , 2017
Evidence based health
maintenance protocols (screening)
in adult/elderly

2. Session plan
 Course Title:
 Session Title:
 Time: one hour

3. Learning Objectives
At the end of this lecture we will be able to know
 To identify concept of health maintenance
 To know types of prevention
 To define aim and types of the screening
 To know criteria of screening program.
 To know usptf recommendations for adult &
elderly screening
 To know the CDC immunization schedule
for adult and elderly

4. Session plan
Time Objectives/ILOs
Teaching
/Learning
Methods
Evidence of
objective
achievement
10 min To identify concept of health maintenance
10 min To know types of prevention
5 min To define screening.
5 min To know aim and types of screening program.
5 min To know criteria of screening program.
15 min To know usptf recommendations for adult & elderly screening

7. Health maintenance
 refers to activities that preserve an individual’s
present state of health and that prevent
disease or injury occurrence.
 Examples of these activities include screening
or surveillance , providing immunizations to
prevent illnesses, and health education .

8. Health
maintenance
Screening
Health
education and
counsleing
Immunization

9. Health promotion
 WHO define Health promotion as a process of
enabling people to increase control over, and to
improve, their health. It moves beyond a focus on
individual behaviour towards a wide range of
social and environmental interventions.

10. Health promotion
Examples include providing information and resources
in order to:
 Enhance nutrition
 Integrate physical activity
 Provide adequate housing
 Promote oral health
 Foster positive personality development
Health promotion is concerned with developing sets of
strategies that seek to foster conditions that allow
populations to be healthy and to make healthy
choices (World Health Organization, 2001).

12.  While it is clear that health promotion and health
maintenance activities are closely linked and
often overlap, there are some differences
 Health maintenance focuses on known potential
health risks and seeks to prevent them, or identify
them early so that intervention can occur.
 Health promotion looks at the strengths and
goals of individuals, families, and populations,
and seeks to use them to assist in reaching
higher levels of wellness.

13. Prevention
Definition: prevention is a process of avoiding
target diseases events through specific
interventions.

14. Types of Prevention
 Primary prevention.
 Secondary prevention.
 Tertiary prevention.

15. Primary prevention
Includes actions taken to prevent the occurrence of
the disease such as:
1- Change in life style factors known to be
associated with disease e.g. smoking
cessation, healthy balanced diet, exercise.
2- Sterilization of surgical instrument.
3- Immunization.
4- Control of mosquitoes to prevent malaria.

16. Secondary prevention
Includes actions taken to stop or delay the
progression of the disease in its early (pre-
symptomatic) stages.
Examples:
1- Screening for hypertension.
2- Mammography.

17. Tertiary prevention
 It is the care directly associated with preventing
complications or morbidity in persons with
established symptomatic chronic disease.
 The term is usually applied to the rehabilitation
process to restore the patient to the best level of
adaptation when there has been damage of
irreversible nature.

19. Screening
Definition:
It is active detection of disease in apparently
asymptomatic individuals by application of tests,
examinations or other procedures which can be
applied rapidly.

20. Aim of screening
Screening is aiming for early detection of the
disease that can be better controlled if detected
early in apparently healthy individuals.

21. Types of screening
 MASS SCREENING: means screening of the
whole population.
 MULTIPLE OR MULTIPHASIC SCREENING:
the use of variety of screening tests on the
same occasion.
 PRESCREPTIVE SCREENING: for early
detection of disease in apparently healthy
individuals which can be better controlled if it is
detected early

22. Criteria of screening program
(A) Criteria of the disease:
 1- Should be important one.
 2- Should be common enough to warrant a
search for its risk factors and latent stages.
 3- The morbidity and mortality of the untreated
conditions must be substantial.
 4- An effective treatment must exist and should
be more beneficial when applied to the pre
symptomatic stage.
 5- The natural history of the disease should be
understood.

23. Criteria of screening program (cont.)
(B) Criteria of the test:
 1- Should be accepted by the population and
suitable for application.
 2- Should be easy, inexpensive, quickly done and
free from hazards.
 3- Sufficiently sensitive to detect disease during
the asymptomatic stage.
 4- Sufficiently specific to minimize the false
positive test results.

24. Criteria of screening program (con.)
(C) Criteria of the screened populations:
 1- Agreement should be obtained from people
who will be screened.
 2- Patients will benefit from further investigations
and treatment
 3- High prevalence of the disease to justify
screening.

25. GUIDELINES
 ACP, USPSTF, CTF, NCI, NIH, AMA, ACC, AHA,
AUA, ACOG, IOM
 USPSTF
 evidence-based
 frequent updates
 factor in net benefit, quality of the evidence

26.  http://www.ahcpr.gov/clinic/uspstfix.htm

27. USPSTF Ratings
 Recommendation: A - routinely provide to eligible patients.
The USPSTF found good evidence that [the service]
improves important health outcomes and concludes that
benefits substantially outweigh harms.
 Recommendation: B - routinely provide to eligible patients.
The USPSTF found at least fair evidence that [the service]
improves important health outcomes and concludes that
benefits outweigh harms.

28. USPSTF Ratings
 Recommendation: C - no recommendation for or against
routine provision of [the service]
At least fair evidence that [the service] can improve health
outcomes but concludes that the balance of the benefits and
harms is too close to justify a general recommendation.
 Recommendation: D - recommends against routinely
providing [the service] to asymptomatic patients
The USPSTF found at least fair evidence that [the service] is
ineffective or that harms outweigh benefits.

29. USPSTF Ratings
 Recommendation: I - evidence is insufficient to recommend for
or against
Evidence that [the service] is effective is lacking, of poor quality,
or conflicting and the balance of benefits and harms cannot be
determined.

36. Example of

52. ROLE OF FAMILY
PHYSICIAN

53. Definition of PHC
• It is the essential health care made
accessible to the individuals and
community through their full
involvement and participation at a
cost the country and individuals can
afford with a methods that is
scientifically sound and socially
acceptable.

54. Elements (components) of
PHC
• Health education for the prevailing health
problems
• Promotion of proper nutrition and safe supply
• Promotion of safe water and sanitation (sewage
disposal & refuse)
• Vaccination
• Prevention and control of locally endemic
diseases
• MCHC including family planning
• Appropriate treatment of the common health
problems
• Providing EDL

56. Comprehensive Approach
 to manage simultaneously multiple complaints
and pathologies, both acute and chronic health
problems in the individual;
 to promote health and well being by applying
health promotion and disease prevention
strategies appropriately;
 to manage and co-ordinate health promotion,
prevention, cure, care and palliation and
rehabilitation.

57. References
1- WHO, Health promotion
http://www.who.int/topics/health_promotion/en/
2-Khaled S. Al-Gelban, Yahia M. Al-Khaldi, Mohammad
M. Diab.(2007): Family medicine, A practical
approach.
3- Goroll, Allan H.; Mulley, Albert G.) (2007): Primary
Care Medicine, 5th Edition
4- USPTF,
http://www.uspreventiveservicestaskforce.org/Page
/Topic/r
5-CDC
https://www.cdc.gov/vaccines/schedules/hcp/adult.

58. THANK YOU