L. Ebony Boulware, MD, MPH; Spyridon Marinopoulos, MD, MBA; Karran A. Phillips, MD, MSc; Constance W. Hwang, MD; Kenric Maynor, MD; Dan Merenstein, MD; Renee F. Wilson, MSc; George J. Barnes, BA; Eric B. Bass, MD, MPH; Neil R. Powe, MD, MPH, MBA; Gail L. Daumit, MD, MHS
Grant Support: By the Agency for Healthcare Research and Quality contract 290-02-0018.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: L. Ebony Boulware, MD, MPH, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205; e-mail, email@example.com.
Current Author Addresses: Dr. Boulware: 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205.
Dr. Marinopoulos: 10753 Falls Road, Suite 325, Lutherville, MD 21093.
Dr. Phillips: 1830 East Monument Street, Room 8033, Baltimore, MD 21205.
Dr. Hwang: 10490 Little Patuxent Parkway, Suite 610, Columbia, MD 21044.
Dr. Maynor: Geisinger Medical Center, 1000 East Mountain Boulevard, Wilkes-Barre, PA 18711.
Dr. Merenstein: 215 Kober Cogan Hall, 3750 Reservoir Road NW, Washington, DC 20007.
Ms. Wilson: MSc 1830 East Monument Street, Room 8061, Baltimore, MD 21287.
Mr. Barnes: 525 West Redwood Street, Baltimore, MD 21201.
Dr. Bass: 1830 East Monument Street, Room 8068, Baltimore, MD 21287.
Dr. Powe: 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205.
Dr. Daumit: 2024 East Monument Street, Suite 2-500, Baltimore, MD 21205.
The periodic health evaluation (PHE) has been a fundamental part of medical practice for decades despite a lack of consensus on its value.
To synthesize the evidence on benefits and harms of the PHE.
Electronic searches of such databases as MEDLINE and the Cochrane Library, review of reference lists, and hand- searching of journals through September 2006.
Studies (English-language only) assessing the delivery of preventive services, clinical outcomes, and costs among patients receiving the PHE versus those receiving usual care.
Study design and settings, descriptions of the PHE, and clinical outcomes associated with the PHE.
The best available evidence assessing benefits or harms of the PHE consisted of 21 studies published from 1973 to 2004. The PHE had a consistently beneficial association with patient receipt of gynecologic examinations and Papanicolaou smears, cholesterol screening, and fecal occult blood testing. The PHE also had a beneficial effect on patient “worry” in 1 randomized, controlled trial but had mixed effects on other clinical outcomes and costs.
Descriptions of the PHE and outcomes were heterogeneous. Some trials were performed before U.S. Preventive Services Task Force guidelines were disseminated, limiting their applicability to modern practice.
Evidence suggests that the PHE improves delivery of some recommended preventive services and may lessen patient worry. Although additional research is needed to clarify the long-term benefits, harms, and costs of receiving the PHE, evidence of benefits in this study justifies implementation of the PHE in clinical practice.
Conceptual framework developed to guide assessment of the value of the periodic health evaluation.
Pap = Papanicolaou.
Appendix Table. Effect Sizes in Randomized, Controlled Trials by Outcome Assessed*
Summary of literature search and review process (number of articles).
*Total may exceed 1284; several reasons for exclusion at the abstract level were allowed. †A total of 50 articles were included in the data abstraction. These 50 articles represented 33 studies that reported multiple outcomes and multiple follow-ups. ‡Total may exceed 769; several reasons for exclusion at the article inclusion/exclusion review level were allowed. CINAHL = Cumulative Index of Nursing and Alliance Health Literature; PHE = periodic health evaluation.
Table 1. Components of Risk Assessment Described as Part of Periodic Health Evaluation in 33 Studies Included in Literature Review
Table 2. Components of Physical Examination Described as Part of Periodic Health Evaluation in 33 Studies Included in Literature Review
Table 3. Summary of Results from Best Available Evidence to Assess Each Outcome*
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Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, et al. Systematic Review: The Value of the Periodic Health Evaluation. Ann Intern Med. 2007;146:289–300. doi: 10.7326/0003-4819-146-4-200702200-00008
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Published: Ann Intern Med. 2007;146(4):289-300.
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