BACKGROUND AND PURPOSE:

• General health checks (ie., wellness visits, checkups, etc.) are commonly performed in adult primary care, though some trials have raised questions about their value and utility
• Liss et al. (JAMA, 2021) reviewed the evidence on general health checks in multiple outcome domains that may be important to clinicians and patients

METHODS:

• Systematic review
• Inclusion criteria
  • RCTs and observational studies with control groups
• Definition of health checks used in this this review: “Health care encounters that include multiple screenings, and identification of risk factors, with a goal of initiating early interventions to prevent future illness”

RESULTS:

• 19 randomized trials (follow-up 1 to 30 years) | 13 observational studies (follow-up cross-sectional to 5 years)
• General health checks were generally not associated with
  • Decreased mortality
  • Fewer cardiovascular events
  • Decreased cardiovascular disease incidence
• In the South-East London Screening Study (n = 7229), adults aged 40 to 64 years who were invited to 2 health checks over 2 years experienced no 8-year mortality benefit over no screening
  • Screening: 6% mortality
  • No-screening: 5%
• General health checks were associated with increased
  • Detection of chronic diseases (e.g. depression and hypertension)
  • Moderate improvements in controlling risk factors (e.g. blood pressure and cholesterol)
  • Increased clinical preventive service uptake (e.g. cancer screening)
  • Improvements in patient-reported outcomes (e.g. quality of life and self-rated health)
• In the Danish Check-In Study (n = 1104), more patients randomized to receive to a single health check, compared to usual care, received a new antidepressant prescription over 1 year
  • With health check: 5% received new prescription
  • Usual care: 2%
  • P = 0.007
• In a propensity score–matched analysis (n = 8917), a higher percentage of patients who attended a Medicare Annual Wellness Visit underwent colorectal cancer screening
  • Wellness visit: 69% underwent screening
  • No visit: 60%
  • P < 0.01
• General health checks were associated with modest improvements in health behaviors such as physical activity and diet
• In the OXCHECK trial (n = 4121), fewer patients who received annual health checks exercised less than once per month
  • Annual health checks: 68% exercised less than 1 time/month
  • No annual check: 71%
  • Difference 3.3% (95% CI, 0.5% to 6.1%)

CONCLUSION:

• Significant limitations to this study include
  • Study is a review, not a meta-analysis (therefore no pooled effect sizes)
  • General health checks in these studies were generally infrequent with short follow-up durations
  • Uptake for health checks tend to be among advantaged groups who are relatively healthy at baseline or any disorders would have been diagnosed early
• The authors state

Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection or inadequate access to primary care

Learn More – Primary Sources:

General Health Checks in Adult Primary Care: A Review

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