THE DELIVERY OF NON-EVIDENCE BASED PREVENTIVE SERVICES DURING PERIODIC HEALTH EXAMINATIONS

Purpose: Preventive services rated C, D, or I by the US Preventive Services Task Force (i.e., those without evidence for routine use) may take up valuable clinical encounter time during periodic health examinations (PHE). Using direct observation methods, we examine patient-physician discussion of and physician recommendation for nine non-evidence based preventive services during PHEs.

Method: Study physicians (N=64) are internal medicine or family physicians practicing with a salaried medical group in SE Michigan. Study patients (N=484) are insured, aged 50-80 years, and due for colorectal cancer screening at time of a scheduled PHE.  Office visit audio-recordings were evaluated for patient-physician discussion of nine non-evidence based preventive services (clinical breast exam, self breast exam, hormone replacement therapy, coronary heart disease screening, dementia screening, illicit drug use screening, lung cancer screening, physical activity counseling, prostate cancer screening, skin cancer prevention and screening), whether the topic was raised by the patient, and whether the physician recommended the service to the patient in absence of evidence of symptoms or prior disease history.

Result: Patient participants are on average aged 59 years, 65% female and 66% white. The non-evidence based services most likely to be discussed during PHEs were prostate cancer screening (93% of males), physical activity (77%), and coronary heart disease screening (64%). Skin cancer prevention (6%) and dementia screening (9%) were the topics least likely to be discussed. When discussed, patients were relatively more likely to raise dementia screening (57% of discussions), hormone replacement therapy (40%), lung cancer screening (33%), and skin cancer prevention (31%). Physicians were most likely to recommend or deliver prostate cancer screening (87% of males), physical activity counseling (46%), clinical breast exam (39% of females), and coronary heart disease screening (26%).

Conclusion: Some non-evidence based preventive health services are routinely discussed by patients and physicians during PHE. When discussed, these topics are raised by both physicians and patients. Even in the absence of symptoms or personal disease history, the rate of physician recommendation for several non-evidence based services is high. The routine provision of non-evidence based services may decrease time available during the PHE for the delivery of evidence-based preventive services as well as other clinical concerns.