|Year : 2021 | Volume
| Issue : 1 | Page : 8-11
Executive health checkup package at All India Institute of Medical Sciences, Bhubaneswar: A novel approach
Bimal Kumar Sahoo1, Manish Taywade1, Vikas Bhatia2, Binod Kumar Patro1, Sachidananda Mohanty3
1 Department of Community Medicine and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
2 Executive Director, AIIMS, Bibinagar, Telangana, India
3 Medical Superintendent of Hospital, AIIMS, Bhubaneswar, Odisha, India
|Date of Submission||14-Feb-2021|
|Date of Acceptance||14-May-2021|
|Date of Web Publication||29-Jun-2021|
Dr. Manish Taywade
Department of Community Medicine and Family Medicine, Room Number: 322, 3rd Floor, Academic Building, All India Institute of Medical Sciences, Bhubaneswar - 751 019, Odisha
Source of Support: None, Conflict of Interest: None
Early detectionof a disease leads to relatively simple courses of treatment and prevents life-threatening complications. Many health conditions can be corrected or maybe improved through treatment modalities if they are discovered by health screening facilities. Health screening program such as executive health checkup is convenient, affordable, inexpensive, and vastly beneficial for the patients. Hence, health screening saves lives immensely by early detection of diseases and preventing serious complications. It is an effective component of healthcare. It achieves more positive effects than medical treatment and at a lower cost. Health promotion is aimed at influencing people's social circumstances and lifestyles so that their health is improved (or maintained) and disease is prevented.
Keywords: Executive health checkup, noncommunicable diseases, periodical examination, prevention
|How to cite this article:|
Sahoo BK, Taywade M, Bhatia V, Patro BK, Mohanty S. Executive health checkup package at All India Institute of Medical Sciences, Bhubaneswar: A novel approach. Indian J Community Fam Med 2021;7:8-11
|How to cite this URL:|
Sahoo BK, Taywade M, Bhatia V, Patro BK, Mohanty S. Executive health checkup package at All India Institute of Medical Sciences, Bhubaneswar: A novel approach. Indian J Community Fam Med [serial online] 2021 [cited 2021 Nov 29];7:8-11. Available from: https://www.ijcfm.org/text.asp?2021/7/1/8/319931
| Introduction|| |
The concept of health monitoring for noncommunicable disease is gaining importance (NCDs) as it is the leading cause of mortality worldwide. General physicians play a pivotal role in the prevention of disease and health promotion. The epidemiological transition (communicable diseases to NCDs) mandates adopting the concept of early screening of at-risk individuals, and combating premature morbidity and mortality from the NCDs and their life-threatening complications, on the almost three-quarters of all NCD deaths, and 82% of the 16 million people who died prematurely, or before reaching 70 years of age, occur in low- and middle-income countries (LMICs).
| Increasing Burden of Noncommunicable Diseases|| |
NCDs have been projected to increase globally by 15% between 2010 and 2020 (44 million deaths), with an estimated 10.4 million deaths in Southeast Asia. Deaths (premature mortality) before the age of 70 years in several LMICs like India have become a matter of concern.
By influencing the social environment and lifestyle behaviors, we aim at preventing the emergence of risk factors for diseases. Apart from improving the quality of life is also increased due to fewer dreadful complications of NCDs. This indirectly influences the economic burden of the country and also individual families. Such a step reinstates the already depleting faith of common people on government setup in providing adequate healthcare to the needy ones. Although the facilities available at lower levels of healthcare delivery system starting from subcenter to community health centers have been utilized under the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS), still many of the diseases remain undiagnosed due to lack of sophisticated laboratory tests, unlike a tertiary healthcare facility.
| Concept of Executive Health Checkup|| |
The concept of annual and periodic health checkups is not new and gives a good platform for the prevention of diseases and the maintenance of optimum health. An executive health checkup (EHC) is generally designed for individuals aged between 30 and 60 years and is recommended for those who are at a high risk of developing conditions such as diabetes, obesity, hypertension, and heart disease. It also includes an evaluation of cardiovascular health.
| Executive Health Checkup and Periodical Examination|| |
Executive clinics leverage a dual role of opportunistic screening of NCDs as well as the screening of outpatient departments in any tertiary care hospital. An executive checkup package is offered by most hospitals, but the kind of tests and health examinations included in the package differs from one healthcare center to another. A detailed medical history is taken by the doctor along with the physical examination and certain laboratory investigations. Depending on the outcome, referral to a particular specialty or super-specialty is recommended. This initiative conceptualizes an idea of screening in combating premature morbidity and mortality.
The preventive component of community medicine practice has been the beacon whenever the need has been raised in any public health interest. This aspect, although not followed in a government setting, is largely practiced by private institutions.,, Although there is no clear-cut definition of EHCs, the seeds of the idea were sown in the late 19th century in London. Periodic health examination was the initial concept around which the intention of conducting a full-body checkup revolved. Early sickness consultation was a term later but covered the same entities.
| Executive Health Checkup at All India Institute Of Medical Sciences, Bhubaneswar|| |
All India Institute of Medical Sciences (AIIMS), Bhubaneswar, has initiated a biweekly EHC with a maximum of five patients per day. It was started in 2017, and around fourteen hundred beneficiaries have availed the services under the EHC clinic till now. EHC aims to extend the healthy life expectancy of the population, to avoid untimely death, and to improve the quality of life for people with a disease or disability. Generally, the private/corporate hospitals have expensive packages with an exhaustive list of investigations. However, AIIMS, Bhubaneswar, offers a very compact list of investigations [Table 1] and with a minimum charge of Rupees fifteen hundred only.
It is done at the EHC clinic, which is aligned with the NCD prevention clinic. With prior registration at the institute (AIIMS, Bhubaneswar), a person either healthy or sick gets access to the process of EHC. Then, the patient/person visits the EHC clinic where proper history-taking and adequate physical examination are done. After which the patient undergoes the list of investigations available under the EHC package [Figure 1]. Subsequently, based on the examination and reports, the concerned person is either advised medications or referred to the appropriate department for further evaluation and management. However, the frequency of conducting such initiatives depends on the requirement and availability of health resources.
| Beneficiaries For Executive Health Checkup|| |
Adults with family history of diabetes, stroke, obesity and cardiovascular diseases or those with sedentary lifestyle, faulty dietary habits, and alcohol intake, tobacco consumption are the dominant group of beneficiary. In addition, any adult who wishes for regular health checkup are also eligible for the executive health checkup.
| Benefits Of Executive Health Checkup|| |
There are profound benefits of EHCs in government institute (AIIMS, Bhubaneswar), which involves the implementation of various programs and policies such as the NPCDCS, aiming to reduce morbidity and mortality due to chronic diseases. Opportunistic screening of NCDs being one of the major benefits.
Certain investigations such as ultrasonography (USG) and echocardiography (done only on circumstantial requirements) increase the likelihood of incidental findings such as fatty liver and left ventricle hypertrophy (LVH). There is reduced interdepartmental referral time in reaching to a final diagnosis. Government health facility is adequately utilized in providing services at an affordable cost as compared to the private ones. With the affordability of the services, even poor people can utilize the opportunity of an executive health clinic. Due to the high cost of the complete health checkup in corporate hospitals, all sections of the society are still not able to undergo health checkup as a result of which modality of the preventive approach (through early screening) cannot be accomplished.
| Counseling, Treatment, and Referral Mechanism|| |
Beneficiary with abnormal findings is counseled, and those requiring referral mechanisms for respective departments are effectively channelized through these executive health services. The inclusion of tests such as echocardiography justifies the initiative of EHCs. Findings of concentric LVH, subtle changes in the cardiac valves, and diastolic dysfunction because of the corresponding comorbidities dig out the hidden pathological changes that have already taken place in the biological system. Most women underestimate the perimenopausal/menopausal period considering it as a normal physiological phenomenon, and hence, hardly, any of them go for a gynecology consultation. However, they get benefited by the prior screening by USG, and changes in the uterus/ovaries get easily detected followed by a change in the health perception of the individual.
NCDs have become the major burden of diseases of hospital visits nowadays. Early screening and diagnosis followed by appropriate treatment can prevent or delay the occurrence of such diseases. The idea of utilizing services of a health facility in a concentrated manner at EHCs can bring about a significant decline of diseases such as CVD, stroke, and cancer.
Such initiative is a significant step in fulfilling the objectives of the NPCDCS started by the Government of India in 2010. The increase in a sedentary lifestyle, unhealthy dietary habits, and consumption of alcohol and tobacco leads to an increase in NCDs, resulting in premature death and disability rate increased in the last decade.
| Challenges and Opportunity|| |
The effectiveness of the EHCs can be strengthened by optimizing our skills while having a healthy discussion with the patients or their relatives. The chances of complications increases with the long duration of disease. Identifying the risk factors prevents future diseases, and practicing good habits promotes good health. The ambit of the clinic can impact the mental health of the beneficiaries in a very positive manner as it sometimes unleashes hidden stress and conditions such as depression or sexual dysfunction.
Like the saying juice of a full orange comes with a load of peels, this setup has its own drawbacks. It is a time-consuming practice; rural population awareness and the chance of a regular follow-up are minimal. Further, there is an inability of interested ones to get a prior appointment due to tight logging of application forms.
However, despite the above lacuna, there is an opportunity of correcting the loopholes. Steps such as giving adequate time to take the detailed history and doing a comprehensive clinical examination should be stressed upon. Proper counseling of the patients for a regular follow-up if any enhances our effort in providing comprehensive coverage for common diseases and comorbidities. Strengthening the Information Education Communication and Behavior Change Communication activities through outreach approach can trigger the inflow of people from rural communities.
| Conclusion|| |
Executive health clinic in academic institute and tertiary care hospital can offer an opportunity of screening of chronic diseases and promoting healthy lifestyles. The implementation of executive health clinics can be without additional resources to the host institute.
Contribution of Dr. Ambarish Das and Dr. Saswati Sahoo is duly acknowledged.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Omran AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Q 1971;49:50938.
Rijal A, Adhikari TB, Khan JA, Berg-Beckhoff G. The economic impact of non-communicable diseases among households in South Asia and their coping strategy: A systematic review. PLoS One 2018;13:e0205745.
Shewade HD, Chinnakali P. Preventive medicine clinics in hospitals of India: An opportunity missed. Int J Med Public Health 2013;3:115-6. [Full text]
Walker JB. Executive Health Teaching Session. Vol. 2. Record of Society of Actuaries; 1976.
Lubin AN, Young GD Jr. Periodic physical examination – A large investment with a small return. Aerosp Med 1972;43:1141-3.
Directorate General of Health Services. Ministry of Health and Family Welfare. Govt. of India. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke: Operational Guidelines; 2010. Available from: http://health. bih.nic.in/Docs/Guidelines-NPCDCS.pdf
. [Last accessed on 2021 Jan 09].
Kirscht JP. Communication between patients and physicians. Ann Intern Med 1977;86:499-500.
Rosch PJ. Stress and illness. JAMA 1979;242:427-8.
Frank E, Anderson C, Rubinstein D. Frequency of sexual dysfunction in “normal” couples. N Engl J Med 1978;299:111-5.