An example of this is the annual physical examination as part of the employment requirements in many companies. Their evaluation revealed that the use of most of the screening tests included in these packages was not grounded in solid evidence. The lessons learned suggest potential improvements in the future work of the task force and other groups engaged in guideline development.
In the Philippines, two studies also examined some aspects of regular health check-ups. Only those hospitals that agreed to participate in the study were visited for document review. The names of the hospitals involved in the study have been withheld to ensure confidentiality.
Proctosigmoidoscopy- instrumental examination of the rectum and colon to check for tumors and disease. IVP (Optional, 10% discount) - special x-ray of the kidney, bladder and ureters to detect kidney function. Of the 12 hospitals that met the inclusion criteria, only 9 agreed to be part of the study.
This may have led to an underestimation of the frequency and cost of executive investigation packages.
Need for Philippine Guidelines on Regular Health Checkups fPHEXJ. approaches: evidence-based approach, consensus-based approach, or a combination of both. An evidence-based approach uses a systematic synthesis of the literature and makes recommendations based on the strength of the evidence. Fink, 1984) The “decibel factor” (predominance of loudness/s) greatly affects the results of the procedure.
The combined use of the evidence-based approach and formal consensus techniques is becoming increasingly popular. Major setbacks include the time and cost constraints, as well as the difficulty of the process. In developing the guidelines, the Philippine task forces identified, retrieved and reviewed relevant data, both foreign and local.
Based on disease burden, test accuracy, treatment availability, and cost-effectiveness data, an evidence-based recommendation was developed. Factors considered in the modifications were local issues, the applicability of the data to practice, and the experience of the clinician. The determination of the quality of the evidence was based on a systematic consideration of these 3 criteria: 1) incidence or prevalence of the condition;
The recommendations of the Task Forces were largely influenced by only one factor, that of scientific evidence. There is insufficient evidence to recommend for or against the inclusion of the condition in a periodic health examination, but recommendations can be made on other grounds. The prevalence of the asymptomatic state should be based on locally conducted community-based studies.
The accuracy and reliability of the screening test must be based on validation studies conducted in the community. Cost-effectiveness of the screening test and the treatment should be evaluated in properly conducted economic analyses. In the local environment, "experts" strongly influence the beliefs and practices of the less experienced practitioners.
34;experts" strongly influence the beliefs
The Philippine medical community is plagued with problems not only in keeping pace with advances but also with barriers to guideline development. Furthermore, this "ningas-kugon" mentality can also be considered one of the feasibility problems that threaten the implementation of a guideline (see below). Acceptability, unlike validity, reliability, and feasibility, is a measurement problem unique to guideline development.
Even in the absence of political discord, a significant number of clinicians may still not accept a document as "credible" if their views were not represented during the development process. Finally, doubts about the objectivity of the guideline development process can also hinder its acceptance. Validity Threats "Respect for the Elderly", presence of "political" discord, absence of publications, influence of pharmaceutical companies; high dropout or attrition rate during Delphi circulation.
These problems threaten the success of guideline development in developing countries such as the Philippines. In the methods section of this proposal, we describe a guideline development protocol that addresses these issues. The guideline development cycle uses both the evidence-based approach and formal consensus techniques (nominal group and modified Delphi techniques).
The use of the evidence-based approach was adopted because of its inherent advantage in making recommendations based on the results of studies of acceptable quality. The combination of this approach with the use of formal consensus techniques will enable the panel members to discuss issues of generalizability of the evidence to the local scenario as well as other issues that may not be covered by the existing evidence. Finally, the multi-sectoral representation of the panel members provides the opportunity to work with various stakeholders who are important components of clinical decision-making.
In summary, Table 8 shows the various tools used in responding to each of these threats in the development of the guidelines. Threats. Evaluation of the guideline development process by panelists; acceptance of guideline needs by individual physicians and societies or organizations; Although the main goal of the task force was to reach concrete conclusions about individual prevention services, we also formed some general impressions about current approaches to prevention as a whole.
A Need for Philippine Guidelines on Periodic Health Examinations rPHEXJ. tar, simply does not stand up to scientific scrutiny. This is extremely important for people who, because they do not have health insurance or a stable source of care, appear in the medical system only sporadically, and rarely for a pre-planned "checkup." Fifth, for some health problems, community-level interventions may be more effective than clinical preventive services.
Our research suggests that while the clinical practice is a powerful site for prevention, community-based interventions can be even more powerful for achieving goals such as injury prevention or smoking cessation. Costs can be reduced by conscientiously avoiding preventative practices that don't help and instead focusing resources where the evidence says they should. Screening tests are ubiquitous in modern practice, but the principles of screening are largely misunderstood.
Four terms describe the validity of a screening test: sensitivity, specificity, and predictive value of positive and negative results. Therefore, knowledge of the approximate prevalence of the disease is a prerequisite for interpreting the results of screening tests. Timing and length biases distort the apparent value of screening programs; Randomized controlled trials are the only way to avoid these biases.
However, inappropriate application or interpretation of screening tests can rob people of their perceived health, initiate harmful diagnostic testing, and waste healthcare resources. 34; A Comparison of Results of Meta-Analyses of Randomized Controlled Trials and Recommendations of Clinical Experts." JAMA. A review of executive audit practice in nine Metro Manila hospitals from January to December 1996, unpublished report.
Report of the Multisectoral Task Force on the Detection and Management of Hypertension - The Philippine Clinical Practice Guidelines for the Detection and Management of Hypertension. 34; The art and science of integrating cost-effectiveness into evidence-based recommendations for clinical preventive services. “. “Development of Evidence-Based Clinical Practice Guidelines: Lessons Learned by the U.S. Preventive Services Task Force.”.
