National Periodic Health

P Examination Guideline

H Periodic Health Examination )

(Project in Primary Health Centres

E ‫مشروع برنامج الفحص الصحي الدوري الشامل بالمراكز الصحية‬

P Periodic Health Examination Training Program (P.H.ETP) 2014

1434 – 1438
1
Introduction to
PHE:
 PHE Timeline
AMA policy for 1st literature
)Dobell( PHE started annual ex >35 Frame &Carlson

1861 1921 1925 1945-1969 1975 1979 1989-96

1st Study by life

?? the Canadian task USPSTF
insurance company
usefulness of Force for PHE Guide to

AHE ( Morgan & preventive

Roemer) services
 Benefits of PHE

 Provide physicians an opportunity to become familiar with

their patients, and to establish a trusting relationship.
 Stresses the importance of a healthy lifestyle.
 Promote appropriate screening and prevention strategies.
 Natural History of the disease

Preclinical Death
Phase
Stage of
Pre-symptomatic Clinically
pathologic Recovery
stage manifest disease
onset
Disability

Primary Secondary Tertiary

P.H.ETP
5
Levels of prevention
The prevention of the emergence or
 Primordial of risk factors in countries or
population groups in which they
have not yet appeared
 Primary The action taken prior to the onset of
disease, which removes the
possibility that the disease will ever
 Secondary occur.
The action which halts the progress
of a disease at its incipient stage and
prevents complications.”
 Tertiary All the measures available to reduce
or limit impairments and disabilities,
and to promote the patients’
adjustment to irremediable
conditions
P.H.ETP
6
Effective Prevention Program
 Based on scientific evidence
 Supported by effective data system
 Flexible
 Sensitive to ethical issues
 Targeted to recipient most in need
 Muster a variety of community resources.
 Require legislative action and social policy
decision
 Must be continuous
‫• الرؤية‬
‫• أن يكون نموذجا رائد في بناء مجتمع صحي للمساهمة في التنمية‬
.‫الجتماعية والتقتصادية وتحقيق الهداف التنموية للمملكة‬

• Vision To be a role model in achieving the health of

the community leading to socially and economically
productive life and achieving the Health strategic
improvements goals of kingdom of Saudi Arabia
• Mission ‫• الرسالة‬
• To provide gold ‫• تقديم خدمات‬
standard ‫وقائية وتعزيزية‬
evidence based, ‫لكل الفئات‬
age appropriate, ‫العمرية للمجتمع‬
preventive and ‫معتمدة على‬
promotive health ‫احدث البراهين‬
care through ‫من خل ل تطبيق‬
family practice in ‫نظام طب‬
primary health ‫الرسرة في‬
care setting. ‫المراكز‬
 Values ‫القيم‬
Initiative ‫المبادرة‬
Justice and Equality ‫العدالة‬
Teamwork ‫والمساواة‬
Empowerment
Communication ‫العمل‬
Quality and ‫الجماعي‬
Excellence ‫التمكين‬
Motivation ‫التواصل‬
‫الجودة والتميز‬

‫التحفيز‬
 Aim &
Objectives
 ‫الهدف العام للمشروع‬
‫‪AIM‬‬
‫• الهدف العام للمشروع‬
‫• تقديم خدمات وقائية وتعزيزية لكل الفئات العمرية للمجتمع‬
‫معتمدة على احدث البراهين من خل ل تطبيق نظام طب‬
‫الرسرة بمراكز الرعاية الصحية الولية وتفعيل الدور الوقائي‬
‫بها ‪.‬‬

‫‪• AIM To provide evidence based “gold-standard and age-‬‬

‫‪appropriate preventive & health maintenance care‬‬
‫‪through family practice in primary heath care setting‬‬
Objectives of the project‫للمشروع‬ ‫الهداف الخاصة‬
• Preventive & health
‫تقديم الخدمات‬-‫• أ‬
maintenance services: : ‫الوقائية والتعزيزية‬
1.Early detection of cases
‫ الكتشاف المبكر‬-1 •
according to age group
‫للحالت حسب‬
2.Provide counseling and .‫الفئات العمرية‬
advice
‫ تقديم المشورة‬-2 •
3.Age appropriate
‫والرشاد حسب‬
vaccination according to
.‫الفئات العمرية‬
international
recommendation ‫ التحصينات حسب‬-3 •
4.Chemoprophylaxis .‫الفئة العمرية‬
.‫ الدوية الوقائية‬-4 •
 ‫للمشروع‬
Objectives of ‫الخاصة‬ ‫الهداف‬
the project

• Referral of suspected or
confirmed cases for ‫ إحالة الحالت المشتبه‬-‫ب‬ •
management.
.‫بها للتشخيص والعلج‬
• Health education to the
community about periodic ‫توعية المجتمع عن‬-‫• ج‬
health examination &early ‫أهمية الفحص الدوري‬
management of illness. .‫والعلج المبكر للمراض‬
 ‫الفحص الدوري الشامل‬
PHE

: Interventions
Chemoprophylaxis Counseling Screening and
And And Health Early Detection
Immunization Education of diseases
‫المستهدفون ببرنامج الفحص الصحي الدوري الشامل‬
‫‪:Targeted Groups‬‬

‫• جميع الفئات العمرية‬

‫لجميع افراد العائلة‪.‬‬

‫‪• All age-group of‬‬

‫‪family members.‬‬
Project ‫لماذا ؟‬
‫مبررات المشروع‬
Rationale

.‫وزارة الصحة والتوجه الواعي لتحسين الخدمات الوقائية والتعزيزية‬ ‫ دعم‬-1 •

‫) تعزيز الصحة ( هو الهدف ال رستراتيجي الو ل ض من الخ طة ال رستراتيجية لم ستقبل ال صحة بالممل كة‬ •
.‫العربية السعودية‬

Support the Ministry of Health and the conscious

orientation to improve the preventive and promotive
services.
(Health Promotion) is the strategic goal within the
first strategic plan for better future health in kingdom
of Saudi Arabia
P.H.ETP
 ‫لماذا ؟‬
Project ‫مبررات المشروع‬
Rationale
2. Local orientation, ,‫ التوجه المحلي‬-2 •
regional and ‫يييييي والدويييلييي‬
‫القلي م‬
international for the ‫لتطبيق برامج الفحص‬
application of the ‫الدوري الشامل لكافة‬
universal periodic ‫الفئات العمريييييييييييةيي‬
examination of all age ‫ييييعيي لتحقيييييقيي‬
‫للمجت م‬
groups for the
‫مفهوم ال صحة لمحاو لة‬
community to realize
‫الكتشاف المبكر للمراض‬
the concept of health to ‫واكتشاف الفئات الكيييثريي‬
try to early detection of ‫عرضة للصابة بها‬
disease and the
discovery of the most
susceptible to the
groups programs
 ‫لماذا ؟‬
‫مبررات المشروع‬

3. Increased demand and

high ceiling clients and
beneficiaries of the service ‫ زيادة حجم الطلب وارتفاع‬-3 •
expectations of size in the ‫ققققققققققققققققف توتقعات العملء‬
‫س‬
process of accelerating ‫والم ستفيدين من الخد مة في‬
developments and scientific ‫ققققرع التطورات‬
‫طور تقققققققققققاس‬
progress in the medical and ‫قققيقق المجال‬
‫قققيقق ف‬
‫والتقدم العل م‬
technological field ‫الطبي والتكنولوجي‬
Strategies of Implementation of The
Program
Adopt the concept of the Periodic health
examination as a methodology to promote
health
The integration of the periodic health
examination program within the activities and
services provided in public clinics, primary
health care centers.
Guided by the recommendations of global
guidelines and evidence based on scientific
evidence.
Utilization and investment of local and
international experiences in this field.
The introduction of new programs such as
immunizations program for adults according
to the international recommendations.
Training and continuing medical education
Following the methodology of training of trainers.
Provide and training manpower for skills
of health education and counseling
(counsellor.(
Providing preventive services
currently available
Activation of referral
between the various
levels of health system.
‫‪PHE‬‬ ‫مخرجا‬
‫‪outcome‬‬ ‫ت‬
‫‪s‬‬ ‫البرنام‬
‫ج‬
 Outcomes of the project:
the primary (short-term)
1434H) 1
1435H) 2
Allocation
Publishing 1436-1437H) 3
and
training
and
distributio Provide H 1438 )4
of 20 n of the the Follow-up
coordinato guidelines necessary Program
rs, one for the resources
program Performance
coordinato
of the to with
r in each
health periodic implemen periodic
region of health t the reports and
the
examinati program indicators of
on in the in all program
kingdom primary
health performance
health
centers
 Project Outcomes: The final
(impact)

Increase
the life Reduce
expectanc mortality The
identifica
y of the and achievem
individual morbidity tion of
due to non- risk ent of
and
communica factors health
improve
quality of
ble and and act and
communica
life. ble to getting
diseases. prevent to a
or healthy
minimize .society
risks.
Stages of the implementation of
project of the periodic health
Examination program.
‫المشروع‬ ‫مراحل‬
1434 H
>>>>>>>>>>>>>>>
1438 H
• Initializati
A on phase
• Preparation
B phase
• Application
C stage
• Continuous
D improvement
phase
Immunizations for adults
program according to
international recommendations
.( (Td ‫• ثنائي بكتيري كبار‬
.( (influenza ‫• النفلونزا‬
.( ( Hepatitis B ‫ كبار‬B ‫• اللتهاب الكبدي ب‬
(Pneumococcal polysaccharide). ‫• المكورات العقدية‬
.( MMR ) ‫• الثلثي الفيروسي‬
.‫• الجديري المائي‬
.(( Meningococcal meningitis ‫• الحمى الشوكية‬
.(Hepatitis A)‫• للتهاب الكبدي أ‬
.Zoster •
 GUIDE LINE
METHODOLOGY
 Methodology
• The Development committee of periodic health
examination tried to find the most reputable
international task force recommendation.
• They looked at the sources of evidence and the quality of
recommendations.
• The evidences' resources were appraised using AGREE
tool.
• Other sources of, evidences and recommendation to fill
the gaps were looked for and references were cited
accordingly.
Main Guideline used

Main:
• U.S. Preventive Services Task Force
(USPSTF) www.ctfphc.org main
• Advisory Committee on Immunization Practices
(ACIP)
• The Canadian Task Force on Preventive Health Care
(CTFPHC)
• The Royal Australian College of General
Practitioners (RACGP).
Methodology
• Strength was based on the stated
recommendation grading criteria.
• A or B recommended grade
• The panel members reach a consensus after
discussing the recommendations which fill the gap
based on:
• Currency, Applicability and Prevalence of the
condition in our setting.
The mechanism of implementation of the program
within the primary health care center:

Through the
general clinics
The organizational structure within
the primary health care center:
 The PHE clinic nurse

• Receives the patient and welcomes him/her & fills the

demographic data in the periodic health examination
form
• Provide an idea about periodic health examination
program, its goals and importance to the patient.
The PHE clinic nurse
• Takes the vital signs & calculate the height, weight &
determine the body mass index
• Document the results in the patient's health record.
• Directs the patient to the physician.
GENERAL CLINIC PHYSICIAN
• perform the periodic health examination based on
the PHE Form as follows:
•  Assessment of the patient's history: Complete medical history,
and the current complaint.
• Ask the patient about his/her current treatments, previous
admissions to hospital.
• Inquire about the family history of the patient and history of
allergies in details.
• Inquire about the social & psychological history.
 GENERAL CLINIC PHYSICIAN

• Conduct medical examination based on the forms

after taking permission from the patient.
• Document all lab results of the clinical evaluation
in the forms.
• Laboratory and radiological investigation are
requested based on patient assessment.
GENERAL CLINIC PHYSICIAN
• Refer the cases that need further testing and
evaluation to higher level of health care. Counseling
(refer to the policy of counseling and health advice).
• Updating patient immunizations.
• Schedule PHE according to the forms attached and
patient’s circumstances.
• Direct the patient to the nurse in charge to give him
next appointment.
 ‫الموارد والحتياجات لعيادة الفحص الدوري‬
‫الشامل‬

Resources and needs of the periodic health examination clinic

 ‫تجهيزات عيادة الفحص الصحي الدوري الشامل‪:‬‬
‫تسلسل‬ ‫إسم الصنف‬ ‫العدد‬
‫‪ ‬‬ ‫‪.1‬‬ ‫سرير كشف )عيادة الطبيب (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫كشاف جيب )تورش( )عيادة الطبيب (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫ستارة لسرير الكشف معلقة بالسقف )عيادة الطبيب (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫جهاز قياس ضغط دم معلق على الجدار مع كفات للكبار والطفال وزائدى الوزن‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫سماعة طبية‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫مجموعة فحص أنف وأذن وحنجرة وعين معلقة على الجدار‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫ميزان كبارالكترونى مع مقياس طول‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫ميزان للصغار مع مقياس طول )عيادة الطفل السليم (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫مطرقة طبية مع ابرة وفرشاة لفحوصات العصاب )عيادة الطبيب (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫شوكة رنانة "‪) "Tuning Fork‬عيادة الطبيب (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫الشعرة الحادية ) ‪( Monofilament‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫ترمومتر ألكترونى معلق على الجدار‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫لوحة مضيئة لقياس حدة البصار )لوحة كشف النظر ‪Snellen chart‬‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫طقم كامل لخذ عينة مسحة عنق الرحم‬ ‫‪2‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫ثلجة كهرائية لحفظ اللقاحات )قسم التطعيمات (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫ترمومتر قياس درجة حرارة الثلجة )قسم التطعيمات (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫مستلزمات سلسلة التبريد‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫صندوق تبريد متوسط الحجم )قسم التطعيمات (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫صندوق تبريد صغير )قسم التطعيمات (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫طاولة آلت متحركة )قسم التطعيمات (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫)قسم التطعيمات (‬ ‫دولب أدوية‬ ‫‪1‬‬
‫الثاث والتجهيز غير الطبى‬
‫‪ ‬‬ ‫‪.1‬‬ ‫سلم معدنى درجتين‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫مكتب ثلثة أدراج )للممرضة(‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫كرسى دوار‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫كرسى مراجع‬ ‫‪2‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫طاولة شاى‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫دولب باب زجاجى )لحفظ السجلت والمطبوعات (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫حاسب آلى )برنامج الفحص الدوري الشامل للفئات العمرية المختلفة (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫لوحة اعلنات فليينية‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫جهاز تليفون )خط هاتف داخلي وخارجي (‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫مكيف سبليت‬ ‫‪1‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫ستائر للشبابيك‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫حوض لغسل اليدين )عيادة الطبيب (و )عيادة الممرضة (‬ ‫‪1‬‬
‫السجلت والمطبوعات‬
‫‪ ‬‬ ‫‪.1‬‬ ‫سجل الكشف الدوري‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫سجل مواعيد و بطاقات مواعيد للمراجعين‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫مطبوعات خاصة بنماذج الفحص الدوري الشامل‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫مطبوعات طلب الفحوصات و الحالة‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫نماذج الحصائيات اليومية والشهرية‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫مطبوعات توعوية للمجتمع عن الفحص الطبي الدوري وعن بعض المشاكل الصحية‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫أدوات قرطاسية‬ ‫‪ ‬‬
‫الفحوصات المخبرية‬
‫‪ ‬‬ ‫‪.1‬‬ ‫فحص الدم الكامل )‪(CBC‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫تحليل السكر)‪(BS‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫تحليل الدم المخفي في البراز)‪(Stool for occult blood‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫حليل الدهون بالدم )‪TC, TG, LDL, HDL‬‬ ‫‪ ‬‬
‫الدوية الوقائية‬
‫‪ ‬‬ ‫‪.1‬‬ ‫حمض الفوليك )حمض الفوليك ‪(0.8mg/day-0.4‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫السبرين ))‪not recommended‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫كالسيوم وفيتامين د‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫الفلواريد للسنان‬ ‫‪ ‬‬
‫التطعيمات )فئة الكبار ( حسب الجداول المعتمدة عالميا‬
‫‪ ‬‬ ‫‪.1‬‬ ‫ثنائي بكتيري كبار )‪(Td‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫النفلونزا )‪(influenza‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫اللتهاب الكبدي ب ‪ B‬كبار )‪Hepatitis B‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫المكورات العقدية)‪(Pneumococcal polysaccharide‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫الثلثي الفيروسي‪MMR‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫الجديري المائي‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫الحمى الشوكية) ‪( Meningococcal‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫اللتهاب الكبدي أ)‪Hepatitis A‬‬ ‫‪ ‬‬
‫‪ ‬‬ ‫‪.1‬‬ ‫‪zoster‬‬ ‫‪ ‬‬
Periodic health examination models
according age groups:

• Periodic examination of the age group below 6 years.

• Periodic examination for the age group 6-17 years.
• Periodic examination for the age group 18-60 years.
• Periodic examination of the age group above 60 years.