Improving the periodic health examination: use of a screening flow chart for patients and physicians

An attempt was made to improve periodic health examinations in a family practice department. Both physicians and patients were instructed in the use of a screening flow sheet that listed the clinic's minimum recommendations for the periodic health examination. Both groups were also educated about the evidence against ordering other tests routinely, such as x-ray examinations and blood tests. Audits were performed before and after physician and patient education on a total of 384 charts. Compliance with all of the screening flow-sheet recommendations improved with education. Significant improvements occurred with the ordering of the tetanus-diphtheria booster and proctosigmoidoscopy examinations. Compliance for most procedures, however, remained well below the recommended level. Unnecessary testing was not decreased by the educational effort. The complete blood count was actually ordered significantly more often after patient education despite the lack of evidence of its value in screening. Although physician and patient education in the use of the screening flow sheet did result in some improvement in the ordering of recommended tests, the optimal method of improving periodic health examinations has yet to be found.