Luckmann R, Melville S K
Department of Family and Community Medicine, University of Massachusetts Medical Center, Worcester 01655, USA.
J Fam Pract. 1995 Jun;40(6):547-54.
The routine periodic health evaluation (PHE) is a popular format in primary care practice for the delivery of clinical preventive services to adults, but knowledge of the current pattern of use and of the content of the PHE is limited.
We surveyed a random sample of 567 family physicians (response rate, 60.1%) in New England regarding their approach to and attitudes about the PHE of adults.
Family physicians reported spending a mean of 35.2% (11.6 hours per week) of their total ambulatory care time on adult PHEs, which were usually scheduled for 20 to 30 minutes each. All respondents recommended a PHE to men > or = 50 years old and to women > or = 40 years old, and more than 90% recommended a PHE to younger patients. Most physicians (80.7%) reported that the PHE is their primary mechanism for delivering preventive services, and 90.6% believed that the PHE should include a comprehensive physical examination. The mean number of physical examination items performed during the PHE was 11.6 to 13.9, depending on patient age and sex. As part of the PHE, most physicians (71.6% to 90.7%, depending on patient age and sex) ordered one or more screening laboratory tests not recommended by the US Preventive Services Task Force. Utilization of fewer laboratory tests was associated with residency training, employment in a health maintenance organization (HMO), and limited concern about malpractice suits.
Family physicians reported spending a substantial amount of time on the PHE of adults, performing extensive screening physical examinations and many screening laboratory tests of unknown effectiveness. Among family physicians, there is considerable unexplained variation in the form and content of the PHE.
常规定期健康评估（PHE）是基层医疗实践中为成年人提供临床预防服务的一种常见形式，但目前对其使用模式和内容的了解有限。
我们对新英格兰地区567名家庭医生进行了随机抽样调查（回复率为60.1%），了解他们对成人PHE的方法和态度。
家庭医生报告称，他们将门诊总护理时间的平均35.2%（每周11.6小时）用于成人PHE，每次PHE通常安排20至30分钟。所有受访者都建议对50岁及以上男性和40岁及以上女性进行PHE，超过90%的受访者建议对年轻患者进行PHE。大多数医生（80.7%）报告称，PHE是他们提供预防服务的主要机制，90.6%的医生认为PHE应包括全面的体格检查。根据患者年龄和性别，PHE期间进行的体格检查项目平均数量为11.6至13.9项。作为PHE的一部分，大多数医生（根据患者年龄和性别，比例在71.6%至90.7%之间）开出了一项或多项美国预防服务工作组未推荐的筛查实验室检查。较少进行实验室检查与住院医师培训、在健康维护组织（HMO）工作以及对医疗事故诉讼的有限担忧有关。
家庭医生报告称在成人PHE上花费了大量时间，进行了广泛的筛查体格检查和许多效果未知的筛查实验室检查。在家庭医生中，PHE的形式和内容存在相当大的无法解释的差异。
