Systematic review: the value of the periodic health evaluation.

BACKGROUND: The periodic health evaluation (PHE) has been a fundamental part of medical 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 September 2006. STUDY SELECTION: Studies (English-language only) assessing the delivery of preventive services, clinical outcomes, and costs among patients receiving the PHE versus those receiving usual care. DATA EXTRACTION: Study design and settings, descriptions of the PHE, and clinical outcomes associated with the PHE. DATA SYNTHESIS: 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. LIMITATIONS: 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. CONCLUSIONS: 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.

Duke Scholars

Author L. Ebony Boulware Medicine, General Internal Medicine