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Primary care doctors are under growing pressure to increase productivity. The result is fewer and shorter visits with patients, with acute illness given high priority. Preventive care, such as the periodic health examination (PHE), may be given less attention than it deserves. This is unfortunate, given that a new study shows that people who are given regular PHEs have significantly lower rates of emergency department use and preventable hospitalizations than those who don't receive PHEs.
The PHE consists of a detailed medical history, targeted physical examination, and age- and sex-appropriate counseling and screening tests. It is not a complete physical appraisal, so it should be possible to integrate the PHE into "sick" visits, note Anna E. Plauth, M.D., M.P.H., of Palo Alto Veterans Hospital, and Steven D. Pearson, M.D., M.Sc., of Harvard Pilgrim Health Care.
In a study supported by the Agency for Healthcare Research and Quality (National Research Service Award fellowship F32 HS00119), they reviewed computerized data from a large staff-model health maintenance organization (HMO) to compare the use of preventive services, use of medical services, and preventable use of services among members who received regular PHEs with an age-matched sample of those who did not. Despite the HMO's stress on the importance of PHEs, including a sophisticated clinical reminder system to provide PHEs, many eligible HMO members did not receive them according to the schedule suggested by the HMO.
In fact, during the 2-year period from 1994 to 1996, nearly one-third of patients in the sample who were older than 40 and one-fourth of those older than 50 did not receive PHEs. Patients without PHEs were markedly less likely to receive standard screening tests (mammography 52 vs. 91 percent; Pap tests 54 vs. 95 percent; blood pressure checks 90 vs. 99 percent; and fecal occult blood testing, 22 vs. 83 percent) or preventive services commonly recommended for their age group. No-exam patients older than 40 years had twice the rate of preventable ED visits (14 vs. 6 per 1,000 members per year), three times more preventable hospital admissions (12 vs. 4), and more than six times the number of preventable hospital days (95 vs. 14) than age-matched patients in the exam group.
Details are in "Missed opportunities: Prevention and resource utilization among HMO members who do not receive periodic health examinations," by Drs. Plauth and Pearson in the March 2000 Preventive Medicine in Managed Care 1(1), pp. 35-42.
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