The American Academy of Family Physicians (AAFP) has updated the Summary of Policy Recommendations for Periodic Health Examinations. The report originated with the Commission on Clinical Policies and Research and was approved by the AAFP Board of Directors in August 1996, with the latest revisions being approved in August 2001. The recommendations and age charts are available at www.aafp.org/exam.
The basis for the recommendations is the analysis of scientific knowledge available as presented by the U.S. Preventive Services Task Force in the Guide to Clinical Preventive Services, 2d ed., and ongoing updates. The report was developed with some consideration of overall cost and patient preferences. Costs were not specifically calculated but were estimated to include broad economic impact and opportunity costs. Patient preferences also were not explicitly stated, but the Working Group on Periodic Health Examinations, the commission, and the board served as surrogates.
The recommendations include the examinations that should be offered (strongly recommend and recommend), those that should not be done (recommend against), those considered an option (no recommendation for or against), and those with insufficient evidence to recommend for or against.
Strongly Recommend. Good quality evidence exists that demonstrates substantial net benefit over harm; the intervention is perceived to be cost effective and acceptable to nearly all patients.
Recommend. Although evidence exists that demonstrates net benefit, the benefit is only moderate in magnitude or the evidence supporting a substantial benefit is only fair. The intervention is perceived to be cost effective and acceptable to most patients.
No Recommendation for or Against. Good or fair evidence exists of at least a small net benefit. Cost effectiveness may not be known or patients may be divided about acceptability of the intervention.
Recommend Against. Good or fair evidence that demonstrates no net benefit over harm.
Insufficient Evidence to Recommend for or Against. No evidence of even fair quality exists, or the existing evidence is conflicting.
Recommendations are made for the general population and specific populations. The general population includes persons who are asymptomatic and not known to be at any increased risk except based on their gender, age, or for specific parameters that apply to substantial groups within the general population. For example, the charts contain recommendations on tobacco use even though not all members of the general population smoke.
Recommendations for specific populations address the health concerns of persons based on their health behaviors, living environment, medical history, or other factors other than gender or age. For example, the recommendation for fluoride supplementation may apply to the majority of children in one practice and none in a practice in another geographic location. Physicians are encouraged to review the needs of individual patients and the populations in the communities they serve to determine which specific recommendations need to be implemented systematically in their practices.
These recommendations are for screening only; they do not necessarily apply to patients who have signs or symptoms relating to a particular condition; and they are not presented specifically relating to women who are pregnant.
These recommendations are provided only to assist physicians in making clinical decisions about the care of their patients. They cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician.