Periodic Preventive Health Visits

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    Choosing Wisely Canada

    This article aligns with Choosing Wisely Family Medicine Recommendation #8


    This peer-reviewed article has been endorsed by the Nurse Practitioner Association of Canada (NPAC).

    This is a peer reviewed article

    Periodic preventive health visits: A more appropriate approach to delivering preventive services (2017)

    The traditional annual physical examination of asymptomatic adults is not supported by evidence of effectiveness and may result in harm. There is better value in a periodic (i.e., according to age, risk, and specific test intervals) preventive visit to provide preventive counseling and screening tests proven to be of benefit. Periodic preventive visits are particularly useful for people older than 65 years of age.

    An annual physical examination of asymptomatic adults typically includes a review of the patient’s health history, medications, allergies, and organ systems, and a complete physical examination that may be followed by laboratory testing and discussion of health risks, life style behaviour, and social situation. A systematic review of 14 randomized controlled trials (RCTs) indicated that these general checkups do not reduce total mortality, cardiovascular mortality, or cancer mortality.

    In comparison, a periodic preventive health visit  of asymptomatic adults involves  scheduling visits based on the age, sex, and health conditions of the individual to provide preventive counseling, immunization, and known effective screening tests. A meta-analysis of 19 trails on periodic preventive health visits among people older than 65 years indicated a decrease in mortality and increase in their likelihood of living independently in the community.  This approach allows for a more detailed discussion of the benefits and risks of screening and a shared decision making approach in the context of each patient’s particular circumstances.

     

    Recommendation:

    • We recommend that primary care practitioners adopt periodic preventive health visits instead of providing annual physical examinations for the delivery of preventive services.