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

2. 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.

3. 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

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

5. Evidence Based Recommendations

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

7. 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.

8. 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.

9. 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.

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

11. 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.

12. 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

13. 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

14. 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.

15. Sources for information of PHE
AAFP recommended periodic-health-examinationwww.aafp.org/fpr/970300fr/5.html
Canadian Task Force on Preventive medicine.
NHS Screening.
PHE.
PHE.

16. 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

17. 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...

18. Thanks