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General Health Checks in Adult Primary CareA Review

Educational Objective
To understand the benefits of annual health checks.
1 Credit CME
Abstract

Importance  General health checks, also known as general medical examinations, periodic health evaluations, checkups, routine visits, or wellness visits, are commonly performed in adult primary care to identify and prevent disease. Although general health checks are often expected and advocated by patients, clinicians, insurers, and health systems, others question their value.

Observations  Randomized trials and observational studies with control groups reported in prior systematic reviews and an updated literature review through March 2021 were included. Among 19 randomized trials (906 to 59 616 participants; follow-up, 1 to 30 years), 5 evaluated a single general health check, 7 evaluated annual health checks, 1 evaluated biannual checks, and 6 evaluated health checks delivered at other frequencies. Twelve of 13 observational studies (240 to 471 415 participants; follow-up, cross-sectional to 5 years) evaluated a single general health check. General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For example, 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, compared with adults not invited to screening, experienced no 8-year mortality benefit (6% vs 5%). General health checks were associated with increased detection of chronic diseases, such as depression and hypertension; moderate improvements in controlling risk factors, such as blood pressure and cholesterol; increased clinical preventive service uptake, such as colorectal and cervical cancer screening; and improvements in patient-reported outcomes, such as 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 with those randomized to receive usual care, received a new antidepressant prescription over 1 year (5% vs 2%; P = .007). In a propensity score–matched analysis (n = 8917), a higher percentage of patients who attended a Medicare Annual Wellness Visit, compared with those who did not, underwent colorectal cancer screening (69% vs 60%; P < .01). General health checks were sometimes associated with modest improvements in health behaviors such as physical activity and diet. In the OXCHECK trial (n = 4121), fewer patients randomized to receive annual health checks, compared with those not randomized to receive health checks, exercised less than once per month (68% vs 71%; difference, 3.3% [95% CI, 0.5%-6.1%]). Potential adverse effects in individual studies included an increased risk of stroke and increased mortality attributed to increased completion of advance directives.

Conclusions and Relevance  General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment, risk factor control, preventive service uptake, and improved patient-reported outcomes. 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.

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Article Information

Corresponding Author: David T. Liss, PhD, Division of General Internal Medicine & Geriatrics, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Dr, 10th Floor, Chicago, IL 60611 (david.liss@northwestern.edu).

Accepted for Publication: April 12, 2021.

Author Contributions: Dr Liss had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Liss, Uchida, Wilkes, Linder.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Liss, Radakrishnan, Linder.

Critical revision of the manuscript for important intellectual content: All authors.

Obtained funding: Linder.

Administrative, technical, or material support: Wilkes, Radakrishnan, Linder.

Supervision: Liss, Linder.

Conflict of Interest Disclosures: Dr Linder reported stock ownership in Amgen, Eli Lilly, and Biogen outside the submitted work. No other disclosures were reported.

Funding/Support: Dr Liss is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (R18DK110741; R34DK114773), Health Resources & Services Administration/Bureau of Health Professions (UH1HP29963), and United HealthCare Services. Dr Linder is supported by a contract from the Agency for Healthcare Research and Quality (HHSP233201500020I) and grants from the National Institute on Aging (R33AG057383, R33AG057395, P30AG059988, R01AG069762), the Agency for Healthcare Research and Quality (R01HS026506, R01HS028127), and the Peterson Center on Healthcare.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Jonna Peterson, MLIS (Northwestern University Feinberg School of Medicine, Galter Health Sciences Library and Learning Center), for her support and assistance throughout the study search and selection process, including the design and conduct of the MEDLINE search, support during the abstract review phase, and obtaining full-text articles. Ms Peterson received no compensation for her project contributions.

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