through the 1990s and may not accurately represent modern PHE effectiveness.A 2007 systematic review (10 RCTs; 23 observational studies; number of patients not reported) examined the benefits and harms of the PHE in regard to delivery of clinical preventive services (Papanicolaou smears, cholesterol screening, and colorectal cancer screening), patient proximal outcomes (disease detection, blood pressure, and cholesterol), and distal outcomes (costs, disability, hospitalization, and mortality). 2 Participants were 18 years old, with the majority of studies coming from the United States and other studies from the United Kingdom, Canada, Taiwan, Japan, Denmark, and Sweden. The studies ranged widely in practice settings. In this review, PHE was defined as one or more visits with a provider solely for assessing overall health and risk factors for preventable disease. Researchers investigated whether the PHE resulted in greater benefits or a reduction in harms compared with non-PHE visits. The magnitude of effect for each study was measured using a Cohen d effect size and labeled small (#0.25), intermediate (0.26-0.8), or high (.0.8). Outcomes were identified as beneficial (all studies showed benefit), harmful (all studies showed harm), or mixed (mix of beneficial and harmful studies). Outcomes were also classified using the Grading of Recommendations, Assessment, Development, and Evaluation criteria (high rating5unlikely further research would alter conclusion; medium rating5further research could alter conclusion; low rating5likely that further research would alter conclusion) to establish strength of evidence. Only four outcomes (Papanicolaou smear, fecal occult blood testing, cholesterol screening, and patient attitude) demonstrated a beneficial overall effect, with all other outcomes demonstrating a mixed overall effect (see TABLE ). This study was limited by reliance on data collected in the 1960s through the 1990s. The authors also noted the difficult inherent in isolating the PHE as the direct cause of the outcomes studied.
