Ch 9 8th Edition Screening

Chapter 9

ScreeningCopyright 2014 by Mosby, an imprint of Elsevier Inc.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

ScreeningPrimary objective: Detection of a disease in its early stages in order to treat it and deter its progression.

Secondary objective: Reduce cost of disease management by avoiding costly interventions required at later stages.Copyright 2014 by Mosby, an imprint of Elsevier Inc.*


Selection of a Screenable DiseaseDoes its significance warrant its consideration as a community problem?Can the disease be detected by screening?Should screening for disease be done?Health benefitsCost Copyright 2014 by Mosby, an imprint of Elsevier Inc.*


SignificanceThe significance of a disease is the level of priority assigned to the disease or disorder as a public health concernDeterminants of significanceQuality of life Subjective; difficult to estimateQuantity of lifeDisease-specific mortality ratesPrevalence ratesexisting cases (chronic disease)Incidence ratesnew cases (acute disease)Cost to treat (e.g., PKU)Copyright 2014 by Mosby, an imprint of Elsevier Inc.*


Is This Disease/Disorder Screenable? Diagnostic criteriaWell-documented diagnostic criteria desiredScreening instrumentsMust be safe, cost-effective, accurateReliabilityReproducibility of test resultsInterobserver vs. intraobserverValidityAccuracy of the test (distinguish those with/without disease)Sensitivity: Proportion with disease who test positively Specificity: Proportion with disease who test negativelyConsider efficiency/efficacy of mass screening programsCopyright 2014 by Mosby, an imprint of Elsevier Inc.*


Is This Disease/Disorder Screenable? (Cont.)Community resourcesFunds, workers, follow-through, treatment sources, administrative personnelDevelopment of community health programLead agencyoversees developmentPartners with community stakeholdersCommunity assessmentsystematic data collectionTarget population, resources, health needs, program strategies identifiedProgram constraints (e.g., financial, accessible follow-up services) must be addressed Copyright 2014 by Mosby, an imprint of Elsevier Inc.*


Should Screening for the Disease/Disorder Be Done?Is there any benefit to early detection?Are there effective treatments available?Interventions/treatment modalitiesNeed specific interventions that will affect disease progression to justify screeningFollow-up critical to aid implementing interventionsNeed to consider safety of intervention; avoid risks or harmful effectsCopyright 2014 by Mosby, an imprint of Elsevier Inc.*


Ethical ConsiderationsRequest for participation implies a health benefitLimitations of resultsNot diagnostic; identifies those at risk or who need further evaluationControversies of screening resultsMisinterpretation False positives, false negatives: Duty to inform?Cutoff points: Alters when person is disease positive or disease negativeBorderline casesinterpretation changes as guidelines change; when to refer/not referCopyright 2014 by Mosby, an imprint of Elsevier Inc.*


Economic FeasibilityCost-benefit ratioComparison of various outcomes in monetary values (which outcome most beneficial at most reasonable cost)Cost-effectivenessOptimal use of resources to reach desired health outcomeCost-efficiencyPurpose: Efficiency; limited budget to achieve as much desired outcome as possibleCopyright 2014 by Mosby, an imprint of Elsevier Inc.*


Selection of a Screenable PopulationPerson-dependent factorsAge, gender, race/ethnicity, income level, and lifestyleEnvironment-dependent factorsConditions of the workplace, home, and communityCopyright 2014 by Mosby, an imprint of Elsevier Inc.*


Recommended Screenings of the USPSTFThe US Preventive Services Task Force has identified 16 categories in their Guide to Clinical Preventive Services Also includes a section on recommendations for children and adolescents Recommended screenings can be obtained at www.uspreventiveservicestaskforce.org/recommendations.htmCopyright 2014 by Mosby, an imprint of Elsevier Inc.*


The Affordable Care Act and Prevention IncentivesAffordable Care Act (ACA) was passed in 2010Mobilized a public health movement focused on prevention and health promotion; resulted in the National Prevention Strategy ACA requires that preventives services be covered without co-payment or coinsurance by more insurance plans/policies including Medicare and private insurance Introduced Medicare-covered annual wellness programsCreated the National Prevention Council, a group comprised of 17 heads of Federal government agencies, departments, and offices focused on promoting prevention and wellness.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.*


Community GuideOn the community level, many on-line resources currently exist and are being continually developed according to best practice guidelines, to support the nurse in providing optimal preventive services .One excellent free resource is the Community Preventive Services community guide. www.thecommunityguide.org/index.htmlAnother resource is the CDC Reach U.S. community website www.cdc.gov/chronicdisease/resources/publicaions/AAG/reach.htm

Copyright 2014 by Mosby, an imprint of Elsevier Inc.*


Documents

Ch 9 8th Edition Screening