Brief reportLaboratory Screening at Preventive Health Exams: Trend of Testing, 1978–2004
Introduction
One of the most common reasons healthy people visit a primary care physician is for a preventive health exam. At these visits, physicians routinely order a substantial number of screening tests,1, 2, 3 yet expert panels have reported since 1979 that very few tests are truly indicated in apparently healthy people.4, 5, 6, 7, 8, 9
To characterize routine test ordering by primary care physicians, physician test-ordering practices were surveyed from five different times between June 1978 and November 2004. No previous study has looked at changes in laboratory testing at preventive health exams during this lengthy time frame, a period that featured new practice guidelines and efforts at cost containment.
Section snippets
Setting and Population
Questionnaires were distributed to primary care physicians attending a week-long postgraduate conference entitled Update in Family Practice, held in Denver and Estes Park, Colorado, in 1978, 1983, 1988, 1999, and 2004. These conferences presented a wide range of clinical topics, but no conference included more than two sessions devoted to preventive health care. Physicians attending each conference represented a wide geographic area of 35–40 states, although approximately 25% of attendees
Results
The number of surveys collected each year was 688 (1978); 261 (1983); 696 (1988); 402 (1999); and 317 (2004), reflecting variable attendance and two courses per year in 1978 and 1988. Therefore, a total of 2364 surveys was collected, representing a >90% response rate. Respondents were family physicians (70%), internists (10%), and other clinicians (20%). Nearly two thirds (64%) reported that they spent at least half of their time providing general medical care for adults. In 2004, the
Discussion
Laboratory testing has represented a common and valued practice associated with preventive health exams. As in previous studies,1, 2, 3 we also observed substantial use of screening tests at routine new patient visits and checkups. But this study is the first to document trends in self-reported, routine test ordering over an extended time period: 1978 through 2004. In 1978, the surveyed primary care physicians reported ordering many tests at the time of a new preventive health exam (Figure 1,
Conclusion
In the context of concerns about excessive laboratory testing and imaging, these data offer encouragement that apparent overuse of screening tests has changed since 1978. These changes may reflect the influence of evidence-based guidelines published during this period. Nonetheless, current test ordering at checkups remains at a level that exceeds evidence-based recommendations.
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