Screening Programs Flashcards
5/28/19 (26 cards)
Agency for Healthcare research and quality
Look through all research to determine burden of disease on society, pain of individual, cost of screening and treatment, etc. to determine a reliable system to work with
Types of disease prevention
1) Primary - prevention of a disease before it happens (Immunizations, etc.), health promotion
2) Secondary - treatment of complications of a disease to prevent it from worsening or progressing (B-blockers, drug therapy), pre-symptomatic diagnosis and treatment
3) Tertiary - Assistance mitigating an already established bad outcome (OT, PT, rehab), disability limitation
4) Quaternary - Avoidance of unnecessary medical interventions (error in medicine)
Sensitivity
Ability of a test to identify all individuals who actually are positive, including false positives (example of all spirochetes opposed to specifically syphilis)
Specificity
Ability of a test to differentiate between individuals who are positive and negative, such as ignoring false positives
USPSTF
United States Preventative Services Task Force that recommends screening for common diseases
WHO Definition of health
State of complete physical, mental, and social well-being and not merely an absence of disease
State of health (individual level)
reflects the degree to which a person is able to function physically, emotionally, and socially, with or without aid from the health care system.
Measures of health status (community level)
- Mortality data
- Age adjusted death rate
- Health related indexes: quality adjusted life years, healthy life expectancy, general well being adjustment scale
Rationed healthcare and example
Decisions made regarding health treatment based on age, quality of life, etc to determine what kind of treatment a person will receive (no screening for lung cancer over 70)
Important example of primary prevention example
Pre-conceptive care (nutritional activity before even trying to become pregnant)
Community screening
Identifying a subgroup of a population who are at high risk for having asymptomatic disease or who have a risk factor that puts them at high risk
Case finding
Searching for asymptomatic disease while in the clinical setting
Example of where screening tests do more harm than good
PSA (prostate specific antigen), which is highly sensitive but not very accurate
Example of good tertiarty treatment
Diabetes treatment to prevent kidney disease
Screening is NOT…
…Diagnosis
Who gets screened?
- Some screenings are offered to anyone who wants to be (ie blood pressure testing)
- Some screenings are given on a mass basis to almost all people (PKU in infants)
- Some are for select groups of people (sickle cell testing in black individuals, mammogrpahy in women)
Screening test flowchart
Negative - record and inform Positive - perform diagnostic test Negative diagnostic - record and inform Postive diagonostic - start treatment Positive response treatment - continue Negative response treatment - revise treatment and reevaluate
Multiphasic screening
More than one method used in combination (family history, social history, physical examination, diagnostic testing)
Greatest predictor of health
Socioeconomic status
Greatest predictor of socioeconomic status
Education
Social considerations for screening
- Availability of therapy
- cost effective
- quality of life
Reliability
Getting precise results consistently, necessary, but not sufficient in determining validity
Validity
Getting accurate results
What is the most accurate measure of blood pressure?
Inter-arterial measure