2021 Clinical Practice Guidelines on Periodic Health Examination

Abstract

Background and Objective. The first Philippine Guidelines on Periodic Health Examination (PHEX) provided evidencebased recommendations for prevention strategies in the Philippines, published in 2004. This 2021 clinical practice guideline (CPG) on PHEX aimed to update the previous PHEX recommendations to align with the implementation of the Universal Health Care Act. This CPG aimed to guide primary care providers, specialists, patients, and the general public and provide recommendations for safe, accessible, and cost-effective screening practices.

Methods. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including the GRADE Adolopment and Evidence-to-Decision framework (EtD). A multisectoral panel developed the recommendations by a formal consensus method upon evaluation of the evidence on benefits and harms, cost-effectiveness, patient values and preferences, acceptability, feasibility, and impact on equity. A conflicts of interest (COI) committee reviewed, evaluated, and managed the potential or declared conflicts of interest of this CPG's Task Force members.

Results. The 2020 PHEX CPG had 23 recommendation statements. Strong recommendations were made to screen for the following conditions 1) Hypertension, 2) Type 2 Diabetes Mellitus using fasting blood sugar, 3) Adult obesity using Body Mass Index (BMI), 4) Unhealthy alcohol use in adults, 5) Tobacco smoking, 6) Colorectal cancer, and 7) Cervical cancer.

Weak recommendations were developed to screen for the following: 1) Lipid disorder among adults with cardiovascular risk factors, 2) Type 2 DM using HBA1C, 3) Acute malnutrition in children, 4) Unhealthy alcohol use in adolescents, 5) High-risk sexual behavior, 6) Depression, and 7) Pulmonary Tuberculosis using chest X-ray.

On the other hand, strong recommendations were also made AGAINST screening for the following: 1) Developmental delay using developmental screening tools, 2) Coronary artery disease using ECG, and 3) Chronic Kidney Disease (CKD) using serum creatinine.

Weak recommendations were also formulated AGAINST screening for the following: 1) Anemia using hemoglobin and/or hematocrit, 2) CKD using urinalysis, and 3) Lung cancer using chest X-ray.

Conclusion. This guideline encourages adherence without restricting clinical judgment or patient-specific considerations. It also informs payers and policymakers without serving as the sole basis for financial or legal decisions. The strong recommendations in this CPG can be used as quality-of-care indicators when evaluating primary care programs. The recommendation statements will be updated at least every three years or as new evidence emerges.