Brief report
Laboratory Screening at Preventive Health Exams: Trend of Testing, 1978–2004

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Background

Routine laboratory screening at preventive health exams continues to be a common practice despite expert opinion dating back to 1979 that supports only a few screening tests for apparently healthy adults. This report describes trends in such testing over a 27-year period.

Methods

Primary care physicians were surveyed five times between 1978 and 2004 at a yearly educational meeting in Colorado. Based on case vignettes describing two apparently healthy adults, physicians indicated which laboratory tests they would routinely order.

Results

Of a total of 2364 surveys collected during years 1978, 1983, 1988, 1999, and 2004, the corresponding percentage of physicians respondents who state they would order the following tests for a healthy man aged 35 years were: complete blood count (CBC) (87, 75, 73, 49, 46); urinalysis (UA) (93, 86, 79, 52, 44); chemistry panel (CHEM) (57, 48, 36, 43, 55); and electrocardiogram (ECG) (37, 27, 24, 9, 6). For a healthy woman aged 55 years, the corresponding percentages for each test were: CBC (89, 89, 86, 64, 67); UA (96, 93, 88, 62, 55); CHEM (70, 70, 66, 57, 76); ECG (63, 51, 51, 33, 29); and thyroid stimulating hormone (14, 20, 28, 42, 57).

Conclusions

Although currently practicing physicians continue to report that they order screening tests for apparently healthy people, this practice appears to have decreased over the past 27 years. This trend may reflect expert guidelines and emphasis on medical cost containment.

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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