Authors' objectives:

The aim of this report was to systematically review evidence on definitions of the periodic health evaluation (PHE), its associated benefits and harms, and system-level interventions to improve its delivery.

Authors' results and conclusions: Among 36 identified studies (11 RCTs), definitions of the PHE varied widely. In studies assessing benefits, the PHE consistently improved (over usual care) the delivery/receipt of the gynecological exam/Pap smear (2 RCTs, small effect (Cohen's d (95% confidence interval (CI)): 0.07 (0.07,0.07)) to large effect (Cohen's d (CI): 1.71 (1.69, 1.73)), strength and consistency graded "high"); cholesterol screening (1 RCT, small effect (Cohen's d (CI): 0.02 (0.00,0.04)) with large associations in 4 observational studies, graded "medium"); and fecal occult blood testing (2 RCTs, large effects (Cohen's d (CI): 1.19 (1.17, 1.21) and 1.07 (1.05, 1.08)), graded "high"). Effects of the PHE were mixed among studies assessing delivery/receipt of counseling (graded "low"), immunizations (graded "medium") and mammography (graded "low"). In one RCT, the PHE led to a smaller increase in patient "worry" (13%) compared to usual care (23%) (graded "medium"). The PHE had mixed effects on serum cholesterol (graded "low"), blood pressure, body mass index, disease detection, health habits and health status (graded "medium"). The PHE had mixed effects on hospitalization (graded "high") costs, disability, and mortality (graded "medium"). No studies assessed harms. Delivery of the PHE was improved by scheduling of appointments for PHE (1 RCT, medium effects (Cohen's d (CI): 0.69 (0.68, 0.70)) and offering a free PHE (1 non-RCT, 22% increase) (graded "medium").

Authors' recommendations: The evidence suggests delivery of some recommended preventive services are improved by the PHE and may be more directly affected by the PHE than intermediate or longterm clinical outcomes and costs. Descriptions of the PHE and outcomes were heterogeneous, and some trials were performed before dissemination of guidelines by the U.S. Preventive Services Task Force, limiting interpretations of findings. Efforts are needed to clarify the longterm benefits of receiving multiple preventive services in the context of the PHE. Future studies assessing the PHE should incorporate diverse populations, carefully define comparisons to "usual care", and comprehensively assess intermediate outcomes, harms, and costs.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/tp/phetp.htm

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)