Americans spend about $7.8 billion a year on physical and gynecological examinations, even though major North American clinical organizations don't recommend the annual visits, according to a new study led by a University of Pittsburgh researcher.

And although two-thirds of patients and physicians believe a yearly check-up is important, patients often don't get important health screenings at those exams and sometimes are given unnecessary tests, researchers concluded in a study published yesterday in the Archives of Internal Medicine.

"We don't say 'yes' or 'no' about whether an annual physical is a good or a bad idea," said Dr. Ateev Mehrotra, the study's lead author and an assistant professor at the Pitt School of Medicine.

Many patients, Dr. Mehrotra acknowledged, believe they should have a physical every year involving lots of medical tests. Yet "there are many doctors who disagree," he said.

"Physicians need to reach greater consensus on what we should advise patients to do."

Dr. Mehrotra, who also is a policy analyst at RAND Corp., and his colleagues analyzed data from outpatient visits conducted from 2002 to 2004.

They found that preventive health and gynecological exams accounted for one in 12 adult ambulatory visits.

About 44.4 million adults -- about one in five members of the nation's adult population -- received a preventive health exam annually.

About 19.4 million women, or 17.7 percent of all adult women, received a preventive gynecological examination.

Many of those preventive health exams included such medical tests as complete blood cell counts or urinalyses, which do not clearly improve patient outcomes, researchers said.

"More than a third of annual physicals include potentially unnecessary testing at a cost of more than $350 million a year," Dr. Mehrotra said.

Researchers also found that 80 percent of certain preventive care services occurred outside of physical exams, and most patients were seen by physicians for another reason during the same year.

"This finding supports the idea advocated by some that we should use other visits as an opportunity to deliver preventive care," Dr. Mehrotra said.

But there were important exceptions, he noted.

Preventive physicals and preventive gynecological exams, for example, were the most common venue for providing services like mammograms and Pap smears.

A relatively small share of counseling services related to diet, tobacco use or exercise, however, was provided in those settings.

The rates of preventive health examinations varied by region, with a resident of the Northeast 60 percent more likely to receive an exam than someone in Western states.

They also varied by insurance coverage, with the uninsured half as likely to receive the examinations as those with private insurance or Medicare.

Dr. David Blandino, chairman of family medicine at UPMC Shadyside, said it is important for patients to receive certain preventive care services, regardless of whether they're delivered at a preventive exam or during some other office visit throughout the year.

"I don't think anyone knows whether health would be better or worse" without the preventive exams, he said.

"There have been questions for some time about whether, or how, to do periodic health exams," said Dr. Douglas K. Owens, who chairs a committee for the American College of Physicians that has been considering whether to adopt guidelines for periodic health exams.

While some preventive services may be delivered at other office visits, there may not be time to do so, particularly if patients have several chronic conditions, said Dr. Owens, who also is a senior investigator for the VA Palo Alto Health Care System and a professor of medicine at Stanford University.

Preventive health exams also may provide an opportunity to assess people who aren't currently being seen for other health problems, he said.

Besides Dr. Mehrotra, other study authors were Drs. Alan Zaslavsky of Harvard Medical School and John Ayanian of Harvard Medical School, Harvard School of Public Health and Brigham and Women's Hospital.