A dults Elizabeth Ellie Richardson MSIII UNMSOM Clinical Case 45 year old woman with an insignificant past medical history and A family history significant for hypertension presents to clinic for her annual exam Last ID: 650653
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The Annual Exam in Asymptomatic Adults
Elizabeth “Ellie” Richardson, MSIII UNMSOMSlide2
Clinical Case
45 year old woman with an insignificant past medical history and A family history significant for hypertension presents to clinic for her annual exam. Last
PaP
smear was 3 years ago with no significant findings and Negative for HPV.
What should be done during her annual physical exam appointment if she has no complaints or concerns? Slide3Slide4
PICO
Patient- Asymptomatic Adults
Intervention- review Annual physical exam components and associated frequencies. Create an EB recommendation for providers.
Comparison- Standard Annual PE exams.
Outcome- Reduced healthcare costs such as unnecessary visits and possible unneeded diagnostic tests; improve patient outcomes Slide5
MESH Terms
MeSH
terms:
Adult; Diagnostic tests, Routine; Humans; Middle aged; Physical Examination
Key words:
Body temperature, respiratory rate, heart rate, auscultation [abdomen, peripheral pulse, lymph node, spleen, liver], digital rectal examination, pulse, hearing tests, breast examination, lung percussion, muscle stretch reflex, and terms for routine Physical ExaminationSlide6
Background
1940’s
Routine annual comprehensive physical examinations became a part of American medical
practice
1980’s
AMA, ACP, USPSTF, and Canadian task force recommended a focused annual physical examination on preventative clinical health outcomes
Tremendous
support from physicians and patients of an annual physical exam
`Physicians endorse the annual pe for reasons such as building rapport with patients, satisfy patients’ expectations, fear of malpractice litigation, and compensation. (Frame 1995,
Prochazka 2005)American Adults showed a 90% endorsement for the annual physical exam according to a 2002 study. (Oboler
2002)Slide7
Description of Study
Purpose- ”Determine whether the routine annual physical examination results in improved outcomes for asymptomatic adults.”
Objective-
Primary: to evaluate the Value of Routine annual PE.
Secondary: If a specific visit increases the likelihood that patients will receive preventive services.
Study design- primary: Reviewed USPTF recommendations; Systematic reviews, computerized literature review- MEDLINE, and JAMA articlesSlide8
Description of Study
Population studied-English speaking, Asymptomatic adult patients
Study Questions-Frequency of physical exams, Efficacy of physical exam components
Conclusion-
1. Comprehensive routine annual
pE
are not recommended for the asymptomatic adult. Components of PE for the asymptomatic adult include: BP screening every 1-2 years, Periodic measurement of BMI, Pap smears (USPTF criteria)
2. Some evidence indicating a specific visit for preventive services may increase the likelihood of PAP smears, cholesterol screening, and FOBT Slide9
Critical Appraisal
The
review addresses a sensible question
because annual Physical exams are routinely scheduled
Search for studies appeared to be exhaustive
Primary objective included 11 references
Secondary Objective included a robust Systematic review
Comprehensively assessed risk of bias in primary
studieS
.
Bias of primary studies carries over; did not directly evaluate specialty society
recommendations, however, Each component of the PE was linked to a specific purpose
Results were clinically applicable and the authors provided a recommendation to providersSlide10
Discussion
The study design was appropriate for the clinical
question
Cons:
Selective inclusion of English speaking adults. Did not assess other groups in the united states such as immigrants, refugees,
Asylees
, and
non-english speakersPros: Large Diverse sample size
Pros of intervention- improve patients outcomes, EB recommendation of an annual physical exam Cons of intervention- ‘Intangible’ benefits of the pE or ‘laying on of hands’ in the strengthening Rapport with patients
I found this to be clinically relevant because of the frequency of annual physical exam appointmentsBefore implementing this intervention I would like additional EB information of the frequency of patients that are lost to follow-up because of the decreased frequency of annual check-ins and hospitalization rates in patients with this implemented intervention
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Tables Slide12
Tables