Cochrane for Clinicians
Putting Evidence into Practice
General Health Checks for Reducing Morbidity and Mortality
Am Fam Physician. 2013 Oct 1;88(7):432-433.
Author disclosure: No relevant financial affiliations.
Do general health checks in adults reduce morbidity and mortality?
Although general health checks increase the number of new diagnoses, they do not decrease total, cardiovascular-related, or cancer-related morbidity or mortality. The studies in this Cochrane review have limited applicability to the current recommended practice of providing selective, evidence-based preventive services in primary care settings. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)
The general health check (also known as the complete physical examination or periodic health evaluation) has been a standard part of medical practice for years. Despite a lack of consensus on the value of the complete physical examination, physicians and patients continue to support it. In fact, 66% of the public think that having an annual complete physical examination is necessary.1 Physicians cite perceived benefits to the physician-patient relationship, patient expectations for a complete physical examination, fear of malpractice litigation, and compensation as reasons to continue performing complete physical examinations.2
In a meta-analysis of 14 randomized controlled trials involving 182,880 adults (median follow-up of nine years), this Cochrane review showed that general health checks in adults did not decrease total, cardiovascular-related, or cancer-related mortality (risk ratio = 0.99 to 1.03). Morbidity outcomes, such as rates of coronary heart disease, cerebrovascular accident, and cancer, also were unaffected. General health checks did, however, increase the overall number of new diagnoses. No effects were noted on hospital admissions, referrals to subspecialists, disability, patient worry, increased visits to physicians, or work absences. Limitations of this review include significant heterogeneity in the trials with different outcome measures, older trials (1963 to 1999) that do not include the potential benefits of newer treatments, and a lack of data on harms such as overdiagnosis and unnecessary resource utilization. Most general health checks took place outside of primary care, and many of the screening tests provided (e.g., urinalysis, electrocardiography, spirometry) have not demonstrated effectiveness in randomized trials.3
Other reviews of the general health check have reached different conclusions. In a systematic review of 21 studies (including 10 randomized controlled trials), the periodic health evaluation was associated with a beneficial effect on patients receiving recommended preventive services, such as Papanicolaou testing, cholesterol screening, and fecal occult blood testing, as well as a decrease in patient worry.4 Another systematic review of 12 studies and guidelines prepared for the Department of Veterans Affairs concluded that periodic screening for hypertension, obesity, and cervical cancer was beneficial, but that performing a routine complete physical examination was not.5
Although the general health check has not been shown to decrease morbidity or mortality, there is some evidence that designating a specific visit for the provision of preventive services may increase the likelihood that patients will receive them. However, the annual complete physical examination may not be the ideal setting. Adding preventive services to other patient visits, sending reminders to patients to use these services, and using community linkages, such as screening at job sites or schools, could be potential avenues for effective delivery of preventive services. Evaluating better models for the delivery of evidence-based preventive services is an area for further research.
The practice recommendations in this activity are available at http://summaries.cochrane.org/CD009009.
Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev. 2012;(10):CD009009.
REFERENCESshow all references
1. Oboler SK, et al. Public expectations and attitudes for annual physical examinations and testing. Ann Intern Med. 2002;136(9):652–659....
2. Prochazka AV, et al. Support of evidence-based guidelines for the annual physical examination: a survey of primary care providers. Arch Intern Med. 2005;165(12):1347–1352.
3. Sox HC. The health checkup: was it ever effective? Could it be effective? JAMA. 2013;309(23):2496–2497.
4. Boulware LE, et al. Systematic review: the value of the periodic health evaluation. Ann Intern Med. 2007;146(4):289–300.
5. Bloomfield HE, et al. Evidence brief: role of the annual comprehensive physical examination in the asymptomatic adult. Project #09-009. VA Evidence-based Synthesis Program Briefs [Internet]. Washington, DC: Department of Veterans Affairs; 2011. http://www.ncbi.nlm.nih.gov/books/NBK82767/pdf/vaphysical.pdf. Accessed December 2012.
These are summaries of reviews from the Cochrane Library.
The series coordinator for AFP is Corey D. Fogleman, MD, Lancaster General Hospital Family Medicine Residency, Lancaster, Pa.
A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.
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