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.