Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
OtherFP Watch

Complete health checkup for adults

Update on the Preventive Care Checklist Form©

Karl Iglar, Sonia Katyal, Roy Matthew and Vinita Dubey
Canadian Family Physician January 2008, 54 (1) 84-88;
Karl Iglar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sonia Katyal
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Roy Matthew
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Vinita Dubey
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • CFPlus
  • eLetters
  • Info & Metrics
  • PDF
Loading

This article has a correction. Please see:

  • Corrections - March 01, 2008

The Preventive Care Checklist Form© is an evidenced-based tool for Canadian family physicians to use at complete health checkups of adults. The complete health checkup of adults is a time for family physicians to focus on preventive health care with their patients. In one study, 94% of primary care physicians felt that annual physical examinations provided an opportunity to counsel patients on preventive health services and improve the doctor-patient relationship.1 Two-thirds of patients responded that the annual physical examination was necessary in addition to regular primary care.2

The Preventive Care Checklist Form incorporates recommendations from the Canadian Task Force on Preventive Health Care (CTFPHC) and recommendations from other sources where the Task Force guidelines are not up-to-date or are lacking. Grade-A (good evidence to include) or grade-B (fair evidence to include) recommendations are delineated by bold and italic text, respectively. Recommendations from other guidelines are in plain text. Practice-relevant components, such as functional inquiry and physical examination, are also included in the form. The form was validated in a prospective cluster randomized controlled trial. Results indicated that using the forms improved the number of evidence-based preventive maneuvers delivered per patient by a 22.8% absolute increase and 46.6% relative increase.3 This means that physicians who used the forms provided almost 50% more recommended preventive services to patients than those who did not use them. Seventy-seven percent of physicians who used the form in the trial indicated they would continue to use it in routine practice.4

The Preventive Care Checklist Form was endorsed by the College of Family Physicians of Canada (CFPC) in June 2004. It is available from the CFPC website,5 with separate forms for men and women, in English and in French. There is also an accompanying explanation sheet. The forms are used in family physicians’ offices across the country in hard copy or as part of an electronic medical record.

In order to keep the Preventive Care Checklist Form up-to-date, relevant, and evidence-based, it is necessary that it be periodically updated. In January 2007, the forms were updated with the most recent evidence and re-endorsed through a peer-review process by the CFPC.

Method

Articles were sought through an Ovid MEDLINE search using the key words mass screening, preventive medicine, adult complete health assessment, and screening guidelines. These results were then limited to Canadian articles published after 2003. As this yielded too few results, specific articles were sought using search terms pertinent to the adult complete health checkup, including colorectal cancer, breast cancer, hypertension, cardiovascular disease, and cervical cancer screening. We also used additional secondary sources, such as articles from the CTFPHC, the Canadian Cancer Society, the National Advisory Committee on Immunization, and the Canadian Medical Association Infobase.

Result

After reviewing all the aforementioned publications, the Preventive Care Checklist Form was updated to reflect current levels of evidence (Table 16–19). The changes based on the CTFPHC recommendations include screening for depression, universal influenza vaccination, screening for diabetes in individuals with hypertension and hyperlipidemia, calcium and vitamin D supplementation for women, and bone density assessment for women 65 years of age and older and those at risk for osteoporosis. The HIV recommendation for high-risk individuals, omitted from the last iteration of the form, has been included. The hormone replacement therapy recommendation has been removed based on current recommendations.

View this table:
  • View inline
  • View popup
Table 1

Updated 2007 recommendations included in the Preventive Care Checklist Form©

Recommendations where the CTFPHC recommendations were lacking or not up-to-date are also presented in Table 16–19 and explained below.

Acellular pertussis vaccine

Pertussis is the least well-controlled vaccine-preventable illness.20,21 The incidence of pertussis has increased since 1990, with the highest rate of increase seen in adults and adolescents. The increase is attributed to waning immunity.20 The National Advisory Committee on Immunization recommends the administration of a single dose of tetanus, diphtheria, and acellular pertussis vaccine to all adults in place of a tetanus-diphtheria booster.14,22

Human papillomavirus vaccine

There is a well-established causal relationship between cervical cancer and infection by multiple types of human papillomavirus.23,24 The National Advisory Committee on Immunization has recommended the human papillomavirus vaccine for girls aged 9 to 13 years.

The recommendation also states that female populations between 14 and 26 years of age can benefit from the vaccine, even if they are or have been sexually active.19

Risk factor stratification for obesity

The body mass index is often used to indicate total fat content. The waist-to-hip ratio and the waist circumference, on the other hand, are considered measures of central or abdominal obesity, which can be a better indicator of obesity-related diseases.11 A high waist-to-hip ratio is defined as greater than 1.0 in men and greater than 0.85 in women,11 and has been shown to be strongly associated with the risk of myocardial infarction.25 Waist circumference, defined as the circumference measured at the midpoint between the lower border of the rib cage and the iliac crest, is a more practical method to assess abdominal obesity.11 Measurements greater than 102 cm (40 in) for men and 88 cm (35 in) for women are considered high-risk indicators for diabetes, coronary artery disease, and dyslipidemia.26 Health Canada has recommended waist circumference as further stratification of risk in both men and women with a body mass index between 18.5 and 34.9.10,26

Colonoscopy for colorectal cancer screening

Colonoscopy has been advocated by some as an alternate screening modality for colorectal cancer27 and some primary care practitioners appear to prefer it.28,29 Colonoscopy has been shown to detect advanced neoplasia, which can be been missed with sigmoidoscopy alone in asymptomatic men and women.30,31 In the Veterans Affairs Cooperative Study, asymptomatic adults from 50 to 75 years of age from 13 centres were screened.32 Participants were screened for advanced neoplasia (defined as an adenoma 10 mm or greater, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer), with rehydrated stool specimens collected on 3 consecutive days followed by a colonoscopy. Sigmoidoscopy was defined as the examination of the rectum and sigmoid during colonoscopy. A subgroup analysis of the 2885 participants who returned the specimens for fecal occult blood testing showed that a colonoscopy can increase the detection rate of colorectal cancer by 24% when compared with the combination of one-time fecal occult blood testing and sigmoidoscopy.32

Both the CTFPHC and the United States Preventive Services Task Force state there is insufficient evidence to recommend for or against using colonoscopy as a screening test for colorectal cancer.33,34 The Canadian Association of Gastroenterology recommends having a colonoscopy every 10 years as a viable screening option for individuals 50 years of age and older who are at average risk for colorectal cancer. In individuals with a family history of adenomatous polyps or colorectal cancer (in a first-degree relative over the age of 60 or 2 or more second-degree relatives), colonoscopy is an option beginning at age 40. If those relatives are younger than 60, a colonoscopic screening is recommended every 5 years beginning either at age 40 or 10 years before the age of the youngest case.12

Hepatitis B screening

Hepatitis B virus infection has declined in incidence because of the increased use of the hepatitis B vaccine. It has virtually disappeared in cohorts offered universal vaccination; however, a substantial proportion of the population is still at high risk for acquiring the infection.14 This includes those who have high-risk sexual activity or unprotected sex, such as individuals having unprotected sex with new partners or those who have had more than 1 sexual partner in the past 6 months, individuals with a history of sexually transmitted infections, and men having sex with men. High-risk groups should be screened for hepatitis B infection15 as part of a sexually transmitted disease test, which includes testing for chlamydia, gonorrhea, HIV, and syphilis.

Vitamin D to decrease cancer

When the 2007 updates were being finalized, the Canadian Cancer Society announced its recommendation for increased vitamin D supplementation for the prevention of cancer. This recommendation has not been included in the Preventive Care Checklist Form because the clinically important level of vitamin D, as it relates to cancer while preventing toxicity, requires further investigation.35

Conclusion

Before the Preventive Care Checklist Form there was no standardized evidence-based form that family physicians in Canada could use for a complete health checkup for adults. In order to remain relevant, the form must be regularly updated to incorporate new evidence for or against certain preventive health maneuvers. The Preventive Care Checklist Form was first endorsed by the CFPC in 2004 and was recently updated in 2007 using relevant literature. The 2007 form provides family physicians with an updated, user-friendly tool to implement best practices in preventive health care. It is meant to be used during complete health checkups for adults who are at average risk. Although the form is comprehensive, physicians should use their discretion and clinical knowledge to determine what maneuvers are required for individual patients.

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. ↵
    1. Prochazka AV,
    2. Lundah K,
    3. Pearson W,
    4. Oboler SK,
    5. Anderson RJ
    . Support of evidence-based guidelines for the annual physical examination: a survey of primary care providers. Arch Intern Med 2006;166(13):1347-52.
    OpenUrl
  2. ↵
    1. Oboler SK,
    2. Prochazka AV,
    3. Gonzales R,
    4. Xu S,
    5. Anderson RJ
    . Public expectations and attitudes for annual physical examinations and testing. Ann Intern Med 2002;136(9):652-9.
    OpenUrlPubMed
  3. ↵
    1. Dubey V,
    2. Mathew R,
    3. Iglar K,
    4. Moineddin R,
    5. Glazier R
    . Improving preventive service delivery at adult complete health check-ups: the Preventive health Evidence-based Recommendation Form (PERFORM) cluster randomized controlled trial. BMC Fam Pract 2006;7:44.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Dubey V,
    2. Glazier R
    . Preventive Care Checklist Form. Evidence-based tool to improve preventive health care during complete health assessment of adults. Can Fam Physician 2006;52:48-55.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Dubey V,
    2. Mathew RGR,
    3. Iglar K
    . The evidence-based Preventive Care Checklist forms. Mississauga, ON: College of Family Physicians of Canada; 2007 [Accessed 2007 Nov 8]. Available from: http://www.cfpc.ca/English/cfpc/communications/health%20policy/Preventive%20Care%20Checklist%20Forms/Intro/default.asp?s=1.
  6. ↵
    1. MacMillan HS,
    2. Patterson CJ,
    3. Wathen CN,
    4. Feightner JW,
    5. Bessette P,
    6. Elford RW,
    7. et al
    . Screening for depression in primary care: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2005;172(1):33-5.
    OpenUrlFREE Full Text
  7. ↵
    1. Cheung AM,
    2. Feig DS,
    3. Kapral M,
    4. Diaz-Granados N,
    5. Dodin S
    . Prevention of osteoporosis and osteoporotic fractures in postmenopausal women: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2004;160(11):1665-7.
    OpenUrl
  8. ↵
    1. Wathen CN,
    2. Feig DS,
    3. Feightner JS,
    4. Abramson BL,
    5. Cheung AM
    . Hormone replacement therapy for the primary prevention of chronic diseases: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2004;170(10):1535-7.
    OpenUrlFREE Full Text
  9. ↵
    1. Abramson BL
    . Postmenopausal hormone replacement therapy for the primary prevention of cardiovascular and cerebrovascular disease. Systematic review and recommendations. Canadian Task Force on Preventive Health Care. London, ON: Canadian Task Force on Preventive Health Care; 2003. Report No. 03-2.
  10. ↵
    Office of Nutrition Promotion and Policy. Canadian guidelines for body weight classification in adults. Ottawa, ON: Health Canada; 2003 [Accessed 2007 Nov 8]. Available from http://www.healthcanada.ca/nutrition.
  11. ↵
    WHO Technical Series. Obesity: preventing and managing the global epidemic. Geneva, Switz: World Health Organization; 2004. Report No. 894.
  12. ↵
    1. Leddin D,
    2. Hunt R,
    3. Champion M,
    4. Cockeram A,
    5. Flook N,
    6. Gould M,
    7. et al
    . Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation: guidelines on colon cancer screening. Can J Gastroenterol 2004;18(2):93-9.
    OpenUrlPubMed
  13. ↵
    1. Wang E
    . Screening for HIV antibody. London, ON: Canadian Task Force on Preventive Health Care; 1991 [Accessed 2007 Nov 8]. Available from: http://www.ctfphc.org/Full_Text/Ch58full.htm.
  14. ↵
    National Advisory Committee on Immunization. Canadian immunization guide. 7. Ottawa, ON: Minister of Public Works and Government Services Canada; 2006.
  15. ↵
    Expert Working Group on Canadian Guidelines for STIs. Canadian guidelines on sexually transmitted infections: 2006 Edition. Ottawa, ON: Public Health Agency of Canada; 2006 [Accessed 2007 Nov 29]. Available from: http://www.phac-aspc.gc.ca/std-mts/sti_2006/sti_intro2006_e.html.
  16. ↵
    1. Feig DS,
    2. Palda VA,
    3. Lipscombe L
    ; Canadian Task Force on Preventive Health Care. Screening for type 2 diabetes mellitus to prevent vascular complications: updated recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 2005;172(2):177-80.
    OpenUrlFREE Full Text
  17. ↵
    Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2003;27(Suppl 2):S1-152.
    OpenUrl
  18. ↵
    1. Langley JM,
    2. Faughnan ME
    . Prevention of influenza in the general population. CMAJ 2004;171(10):1213-22.
    OpenUrlAbstract/FREE Full Text
  19. ↵
    National Advisory Committee on Immunization. Statement on human papillomavirus vaccine. An Advisory Committee statement. Can Comm Dis Rep 2007;33(ACS-2):1-31.
    OpenUrl
  20. ↵
    1. Galanis E,
    2. King AS,
    3. Varughese P,
    4. Halperin SA
    ; IMPACT investigators. Changing epidemiology and emerging risk groups for pertussis. CMAJ 2006;174(4):451-2.
    OpenUrlFREE Full Text
  21. ↵
    1. Brooks DA,
    2. Clover R
    . Pertussis infection in the United States: role for vaccination of adolescents and adults. J Am Board Fam Med 2006;19(6):603-11.
    OpenUrlAbstract/FREE Full Text
  22. ↵
    National Advisory Committee on Immunization. Interval between administration of vaccines against diphtheria, tetanus, and pertussis. An Advisory Committee statement. Can Comm Dis Rep 2005;31(ACS-9):17.
    OpenUrl
  23. ↵
    1. Wallin KL,
    2. Wiklund F,
    3. Angstrom T,
    4. Bergman F,
    5. Stendahl U,
    6. Wadell G,
    7. et al
    . Type-specific persistence of human papillomavirus DNA before the development of invasive cervical cancer. N Engl J Med 1999;341(22):1633-8.
    OpenUrlCrossRefPubMed
  24. ↵
    1. Bosch FX,
    2. Manos MM,
    3. Munoz N,
    4. Sherman M,
    5. Jansen AM,
    6. Peto J,
    7. et al
    . Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. International biological study on cervical cancer (IBSCC) Study Group. J Natl Cancer Inst 1995;87(11):796-802.
    OpenUrlAbstract/FREE Full Text
  25. ↵
    1. Yusuf S,
    2. Hawken S,
    3. Ounpuu S,
    4. Bautista L,
    5. Franzosi MG,
    6. Commerford P,
    7. et al
    . Obesity and risk of myocardial infarction in 27000 participants from 52 countries: a case-controlled study. Lancet 2005;366(9497):1640-9.
    OpenUrlCrossRefPubMed
  26. ↵
    1. Janssen I,
    2. Katzmarzyk PT,
    3. Ross R
    . Body mass index, waist circumference, and health risk: evidence in support of current national institutes of health guidelines. Arch Intern Med 2002;162(18):2074-9.
    OpenUrlCrossRefPubMed
  27. ↵
    American Cancer Society. Can colorectal polyps and cancer be found early? Atlanta, GA: American Cancer Society; 2007 [Accessed 2007 Dec 13]. Available from www.cancer.org/docroot/CRI/content/CRI_2_4_3x_can_colon_and_rectum_cancer_be_found_early.asp.
  28. ↵
    1. Lafata JE,
    2. Williams LK,
    3. Ben-Menachem T,
    4. Moon C,
    5. Divine G
    . Colorectal carcinoma screening procedure use among primary care patients. Cancer 2005;104(7):1356-61.
    OpenUrlCrossRefPubMed
  29. ↵
    1. McGregor SE,
    2. Hilsden RJ,
    3. Murray A,
    4. Bryant HE
    . Colorectal cancer screening: practices and opinions of primary care physicians. Prev Med 2004;39(2):279-85.
    OpenUrlCrossRefPubMed
  30. ↵
    1. Lieberman DA,
    2. Weiss DG,
    3. Bond JH,
    4. Ahnen DJ,
    5. Garewal H,
    6. Chejfec G
    . Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 2000;343(3):162-8.
    OpenUrlCrossRefPubMed
  31. ↵
    1. Schoenfeld P,
    2. Cash B,
    3. Flood A,
    4. Dobhan R,
    5. Eastone J,
    6. Coyle W,
    7. et al
    . Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 2005;352:2061-8.
    OpenUrlCrossRefPubMed
  32. ↵
    1. Lieberman DA,
    2. Weiss DG
    . One-time screening for colorectal cancer with fecal occult-blood testing and examination of the distal colon. Veterans Affairs Study Group. N Engl J Med 2001;345(8):555-60.
    OpenUrlCrossRefPubMed
  33. ↵
    1. McLeod R
    . Screening Strategies for Colorectal Cancer: Systematic Review and Recommendations. Canadian Task Force on Preventive Health Care. London, ON: Canadian Task force of Preventive Health Care; 2001. Report No. 01–2.
  34. ↵
    US Preventive Services Task Force. Screening for colorectal cancer: recommendations and rationale. Ann Intern Med 2002;137(2):129-31.
    OpenUrlCrossRefPubMed
  35. ↵
    Canadian Cancer Society. Key findings released from UV, vitamin D and health conference: national health groups recognize benefits of vitamin D. Toronto, ON: Canadian Cancer Society; 2006 [Accessed 2007 Dec 13]. Available from: www.cancer.ca/ccs/internet/mediareleaselist/0,,3543_434465_1057677808_langId-en,00.html.
PreviousNext
Back to top

In this issue

Canadian Family Physician: 54 (1)
Canadian Family Physician
Vol. 54, Issue 1
1 Jan 2008
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Complete health checkup for adults
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Complete health checkup for adults
Karl Iglar, Sonia Katyal, Roy Matthew, Vinita Dubey
Canadian Family Physician Jan 2008, 54 (1) 84-88;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Complete health checkup for adults
Karl Iglar, Sonia Katyal, Roy Matthew, Vinita Dubey
Canadian Family Physician Jan 2008, 54 (1) 84-88;
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Method
    • Result
    • Acellular pertussis vaccine
    • Human papillomavirus vaccine
    • Risk factor stratification for obesity
    • Colonoscopy for colorectal cancer screening
    • Hepatitis B screening
    • Vitamin D to decrease cancer
    • Conclusion
    • Footnotes
    • References
  • Figures & Data
  • CFPlus
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • Corrections
  • PubMed
  • Google Scholar

Cited By...

  • Mise a jour sur la prevention et le depistage selon lage a lintention des medecins de soins primaires canadiens
  • Update on age-appropriate preventive measures and screening for Canadian primary care providers
  • Examen medical annuel des adultes: Mise a jour sur Soins preventifs - Fiche de controle(C)
  • Annual adult health checkup: Update on the Preventive Care Checklist Form(C)
  • En tete de liste
  • Top of the list
  • Soins primaires aux adultes ayant une deficience developpementale: Lignes directrices consensuelles canadiennes
  • Primary care of adults with developmental disabilities: Canadian consensus guidelines
  • Google Scholar

More in this TOC Section

  • Use of nonvitamin dietary supplements with prescription medications
  • Elliptical excision
  • Hospitalist care
Show more FP Watch

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • RSS Feeds

Copyright © 2023 by The College of Family Physicians of Canada

Powered by HighWire