Systematic Review: The Value of the Periodic Health Evaluation

Systematic Review: The Value of the Periodic Health Evaluation

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; and
Gail L. Daumit, MD, MHS

From the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Medicine, and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Abstract

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.

Article and Author Information

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, lboulwa{at}jhmi.edu.
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.