Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
4
Source: Statistics Canada, 2012. CIHI infographics available from:
https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en#!/indicators/012/avoidable-deaths/;mapC1;mapLevel2;/
MCC Objectives -
Prevention
General Objectives:
Enabling Objectives
Be able to both define the concept of levels of prevention at the individual
(clinical) and population levels, as well as formulatepreventivemeasures
into their clinical management strategies.
Be able to describe the health impact of community-level interventions to
promote health and prevent disease.
Apply the principles of screening and be able to evaluate the utility of a
proposed screening intervention, including being able to discuss the potential
for lead-time bias and length-prevalence bias.
Levels of prevention
Primary preventiona condition is prevented
before it develops by addressing its risk or
protective factors.
Secondary preventionearly detection or
intervention to identify a disease and delay the
progression of an early or preclinical disease and
minimize disability.
Tertiary preventioninterventions that lessen the
impact of disability from fully developed disease
through eliminating, reducing or managing
impairments.
Periodic Health
Examination
History, risk assessment, and a tailored
physical examination that could lead to
delivery of preventive services
Review a patients ongoing medical issues
Counsel for preventive health issues
Improve physician patient relationship
9
MCC Objectives
Periodic Health Exam (74)
Key Objectives
Given a patient presenting for a PHE, the candidate will determine the
patient's risks for age and sex-specific conditions to guide the history,
physical examination, and laboratory screening.
Enabling Objectives
Perform an appropriate history and physical examination based on the
patient's age, sex, and background;
List and interpret appropriate investigations, including:
o evidence-based screening investigations specific to age and sex
concerns (e.g., fasting glucose for greater than 40 years,
mammography for greater than 50 years);
Construct an effective initial management plan, including:
o Communicate effectively with the patient to reach common ground
regarding goals related to disease prevention and risk reduction;
o Recommend proven prevention strategies (e.g., smoking
cessation, regular exercise);
o Incorporate the periodic health examination principles in the care of
a patient with a chronic disease.
Structure of the PHE
Get diagnostic problems out of the way!
History
Physical Exam
Lab tests, diagnostic imaging (screening tests)
Immunizations
Counselling
Other medications/interventions
Approach screening cautiously
Screening seems easy, but is a controversial area
of medicine with an ever-evolving evidence-base
15
Conditions to consider based
on patient age
Some things are good for
almost everybody!
All ages
Injury prevention (e.g., noise control,
seat belts, bicycle helmets)
Lifestyle modification (e.g., physical
activity, smoking prevention/cessation,
sun exposure)
Immunization
For the MCCQE
Focus on the simple stuff i.e. things that apply to
everyone
http://canadiantaskforce.ca/
Targeted and evidence based
Summary of recommendations for
clinicians and policy-makers
Grading of recommendation and evidence
as strong, moderate or weak
19
PHE Resources
National Advisory Committee on
Immunizations (NACI)
http://www.phac-aspc.gc.ca/naci-ccni/
Advisory committee of experts in the fields of
pediatrics, infectious diseases, immunology,
medical microbiology, internal medicine and
public health.
Makes recommendations for the use of vaccines
currently or newly approved for use in humans in
Canada, including the identification of groups at
risk for vaccine-preventable diseases for whom
vaccination should be targeted.
20
PHE Resources
CFPC Preventative Care Checklist Forms
(last updated in February 2015)
http://www.cfpc.ca/projectassets/templates/reso
urce.aspx?id=1184&langType=4105
21
PHE Resources
http://www.rourkebabyrecord.ca/
The Rourke Baby Record is a system that many Canadian
doctors and other healthcare professionals use for well-baby
and well-child visits for infants and children from 1 week to 5
years of age.
22
PHE Resources
Greig Health Record
http://www.cps.ca/tools-outils/greig-health-record
The Greig Health Record, published in 2010 and
updated in 2016, is an evidence-based health
promotion guide for clinicians caring for children and
adolescents aged 6 to 17 years.
Checklist templates include sections for growth and
weight; psychosocial history and development;
nutrition; physical activity and sedentary behaviour;
sleep; injury prevention; abuse; the physical exam;
immunization; and other specific concerns.
Population Infants
Get diagnostic problems out of the way!
History pregnancy, birth, breastfeeding, vision,
hearing, development, abuse/neglect
Physical Exam growth charts, developmental
milestones, eyes (e.g., cover/uncover), hips
Lab tests, diagnostic imaging (screening tests)
hemoglobin if at risk for hemoglobinopathy
Immunizations lots, annual flu (>6mos)
Counselling car seat, sleep position, crib, poisons,
firearms, smoke/CO alarms, dental health, nutrition,
passive smoke
Other meds/interventions Vitamin D 400 IU/day,
home visit
Populations Children
Get diagnostic problems out of the way!
History pregnancy, birth, vision, hearing,
development, abuse/neglect, school readiness
Physical Exam growth charts, developmental
milestones, eyes
Lab tests, diagnostic imaging (screening
tests) - none
Immunizations lots, annual flu (>6mos)
Counselling car seat/ seatbelts, bike helmets,
hearing protection, poisons, firearms, smoke/CO
alarms, dental health, nutrition, passive smoke, no
OTC cough cold/medicines
Other meds/interventions dentist
Populations Adolescents
Get diagnostic problems out of the way!
History HEADSS, diet
Physical Exam growth charts, sexual maturity
Lab tests, diagnostic imaging (screening tests) sexually
transmitted infections
Immunizations DTaP, missed childhood, HPV, Hep B,
annual flu
Counselling seatbelts, bike helmets, hearing protection,
dental health, nutrition, alcohol, smoking, other drugs,
occupational exposures, sun exposure
Other meds/interventions Vitamin D, dentist
http://www.choosingwiselycanada.org/recommendations/family-medicine/
Condition Specific
Screening
Recommendations
Osteoporosis
Quick Reference Guide: 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in
Canada. Available from: http://www.osteoporosis.ca/multimedia/pdf/Quick_Reference_Guide_October_2010.pdf
Hypertension
Prevalence: HTN in 19% of Canadian adults; prevalence
increases with age, comorbidities