Final: Adult Health Promotion Screening Flashcards
What are the 3 components of Health Promotion?
Heath Education
Health Screening
Disease Prevention
What agency oversees preventative services?
USPSTF
United States Preventative Services Task Force
Health screenings are important tools to
detect disease at early stages
Health education about screening is
Primary Prevention
Actual screening process is
Secondary prevention
What are the next steps after detecting the disease in its early stage?
-treat disease
-stop the disease from progressing
What is the financial benefit of early detection?
Reduce cost of disease management by avoiding costly interventions required at later stages
Some diseases proceed by period of
asymptomatic pathogenesis or latency
Individual screening
- 1 person tested
-Often chosen based on risk factors
-Sometimes chased based on universal screening
Example of individual screening
Mammogram for a young adult with a family history of breast cancer
Group or mass screening
target populations selected on basis of increased risk
Example of group or mass screening
-Vision test in school children
-Testing for Phenylketonuria (PKU) in neonates
One-test disease specific screening
-Single test
-Detects characteristics indicating high risk
Example of one-test disease specific screening
-Hemoglobin A1C and diabetes
-Cholesterol levels and hypercholesterolemia
Multiple test screening
2 or more test to detect one disease
Example of multiple test screening
Tuberculosis screening (Tuberculin skin test, interferon gamma-realase assay blood test, chest x-ray, sputum cultures)
Screening Criteria: Detection
-Are there well-documented diagnostic criteria?
-Resources/treatment available to support screening?
Screening Criteria: Diagnostic Criteria
-Disease should have early asymptomatic state
-Risk factors: Who should be screened?
Screening Criteria: Screening Measures
-Must be safe, cost effective, accurate
-Screening tool must accurately distinguish those with and those without disease
Advantages of screening
-Cost effective
-Applied to individual and larger populations
-Some screenings mandated by law
-Can be one test specific or multiple test screening
-creates opportunity for health teaching
Example of individual screening
Blood pressure check in primary care
Example of large population screening
Community blood pressure screening fair
Disadvantages of screening
-Uncertainty in scientific evidence (possibility for error)
-False positives: anxiety, unnecessary interventions
-False negatives: disease is overlooked, missed opportunity for early intervention, false assurance
-Ex. Microcalcification can be false positive which results in invasive breast biopsy
Selection of a “screenable” disease Questions to ask
-Just because we can, does it mean we should?
-Does its significance warrant its consideration as a community problem?
-Can the disease be detected by screening?
-Can it be treated?
-Tangible and intangible (emotional, financial) costs
No clear answer
Screening: Quality of life is
subjective, difficult to assess, individualized
Epidemiology
-Method used to find cause of disease (and outcomes) in populations.
-How different risk factors go together and influence disease
Morbidity
Amount of Disease or disability from any cause in a population
Mortality
Deaths in a given population as a result of a specific disease/illness/event
Significance
Level of priority of disease as public health concern
Incidence
-Rate of a new population problem and estimate RISK of individual developing disease
-Measures new cases
-Acute
(IN= Incidence New)
Prevalence
-Proportion of the population WITH disease at any one point in time
-Measures all cases within a set period
-Chronic
(CP= Current Prevelance)
Reliability
Exact same results every time
Inter-observer
same results when two persons do test
Intra-observer
Same person able to reproduce results
Validity
Measuring what you actually want to measure
Test Sensitivity
the ability of a test to correctly identify those WITH the disease (true positive rates)
Test Specificity
The ability of a test to correctly identify those without the disease (true negative rate)
If you do have a disease, you would have a true positive. So you would say that the test has a
High level of Sensitivity
If you don’t have a disease, you would want a true negative. So you would say that the test has a
High level of Specificity
Can the test correctly identify if a person has diabetes or not? =
Validity
Are the guidelines put forth by the USPSTF set?
No they can change over time
Ex. Mammography guidelines several times over past decade (false positives)
Ex. PSA no longer recommended: treatment harm> benefits early diagnosis
Ethical considerations for Screening?
-Request for participation implies a health benefit
-Need to clarify issues: What are cost to patient? (Financial, emotional, physical)
-Controversies of screening results: False positives, false negatives, duty to inform, cutoff point, borderlines cases
What is the economic cost dilemma?
-Do costs result in improved health?
-Are benefits of screening worth the expenditures required?
Goal: determine optimal use of resources to achieve desired outcome
Three approaches to evaluate economic cost?
- Cost-benefit ratio
- Cost effectiveness
- Cost efficiency analysis
Clinical preventive screenings…
- Save years of life and help people live better during those years
- Save Money
- Provide quality care
- Reduce death, disability, and disease
Who makes up the USPSTF and what do they do?
A panel of experts in primary care and prevention who review the evidence of effectiveness and develops recommendations for clinical preventive services
What is the USPSTF grading recommendations like?
ABCDI
A & B is High recommendation
C is moderate recommendation
D is Discouraged
I is Insufficient, poor evidence
The nursing role in screening
-Development and implementation of screening programs
-Decision maker
-Planner
-Education and counseling
-Follow-up
-Collaborate
-Focus on primary and secondary prevention
