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Support of Evidence-Based Guidelines for the Annual Physical Examination
A Survey of Primary Care Providers
Allan V. Prochazka, MD, MSc;
Kristy Lundahl, MS;
Wesley Pearson, MD;
Sylvia K. Oboler, MD;
Robert J. Anderson, MD
Arch Intern Med. 2005;165:1347-1352.
Background Current evidence does not support an annual screening physical examination for asymptomatic adults, but little is known about primary care provider (PCP) attitudes and practices regarding an annual physical examination.
Methods We conducted a postal survey (32 items) of attitudes and practices regarding the annual physical examination (in asymptomatic patients 18 years or older) of a random sample of PCPs (specializing in internal medicine, family practice, and obstetrics/gynecology) from 3 geographic areas (Boston, Mass; Denver, Colo; and San Diego, Calif).
Results Respondents included 783 (47%) of 1679 PCPs. Overall, 430 (65%) of 664 agreed that an annual physical examination is necessary. Three hundred ninety-three (55%) of 712 disagreed with the statement that national organizations do not recommend an annual physical examination, and 641 (88%) of 726 perform such examinations. Most PCPs agreed that an annual physical examination provides time to counsel patients about preventive health services (696/739 [94%]), improves patient-physician relationships (693/737 [94%]), and is desired by most patients (572/737 [78%]). Most also believe that an annual physical examination improves detection of subclinical illness (545/738 [74%]) and is of proven value (461/736 [63%]). Many believed that tests should be part of an annual physical examination, including mammography (44%), a lipid panel (48%), urinalysis (44%), testing of blood glucose level (46%), and complete blood cell count (39%).
Conclusions Despite contrary evidence, most PCPs believe an annual physical examination detects subclinical illness, and many report performing unproven screening laboratory tests. Primary care providers do not appear to accept recommendations that annual physical examinations be abandoned in favor of a more selective approach to preventing health problems.
Author Affiliations: Ambulatory Care Section, Denver Veterans Affairs Medical Center (Drs Prochazka and Oboler), and Division of General Internal Medicine, University of Colorado Health Sciences Center (Drs Prochazka, Pearson, Oboler, and Anderson and Ms Lundahl), Denver.
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