27.2.07

Systematic review: the value of the periodic health evaluation.

Ann Intern Med. 2007 Feb 20;146(4):289-300.
Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D,Wilson RF, Barnes GJ, Bass EB, Powe NR, Daumit GL.Welch
Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, and Johns Hopkins Bloomberg School of Public Health,Baltimore, Maryland, USA. lboulwa@jhmi.edu
BACKGROUND: The periodic health evaluation (PHE) has been a fundamental part ofmedical practice for decades despite a lack of consensus on its value.
PURPOSE:To synthesize the evidence on benefits and harms of the PHE.
DATA SOURCES:Electronic searches of such databases as MEDLINE and the Cochrane Library,review of reference lists, and hand- searching of journals through September2006. STUDY SELECTION: Studies (English-language only) assessing the delivery ofpreventive services, clinical outcomes, and costs among patients receiving thePHE versus those receiving usual care.
DATA EXTRACTION: Study design andsettings, descriptions of the PHE, and clinical outcomes associated with thePHE.
DATA SYNTHESIS: The best available evidence assessing benefits or harms ofthe PHE consisted of 21 studies published from 1973 to 2004. The PHE had aconsistently beneficial association with patient receipt of gynecologicexaminations and Papanicolaou smears, cholesterol screening, and fecal occultblood testing. The PHE also had a beneficial effect on patient "worry" in 1randomized, controlled trial but had mixed effects on other clinical outcomesand costs.
LIMITATIONS: Descriptions of the PHE and outcomes were heterogeneous.Some trials were performed before U.S. Preventive Services Task Force guidelineswere disseminated, limiting their applicability to modern practice.
CONCLUSIONS: Evidence suggests that the PHE improves delivery of some recommended preventiveservices and may lessen patient worry. Although additional research is needed toclarify the long-term benefits, harms, and costs of receiving the PHE, evidenceof benefits in this study justifies implementation of the PHE in clinicalpractice.