Cholesterol Screening Program and Health Promotion Essay

Introduction

Cholesterol screening has become a common practice in contemporary healthcare institutions. The program ensures timely disease detection and treatment. Early screening of the healthy cholesterol levels in the body paves a way for professional counseling to help the patients change their lifestyles. The practice has been deemed cost-effective since it results in the prevention of diseases that arise from the high levels of cholesterol in the body. This essay provides a critique of the cholesterol-screening program by examining key features and contributions to re-orienting health services.

Background to the Cholesterol Screening Programme

Cholesterol is an essential compound for the normal functioning of the body. In most cases, the body produces its cholesterol for the formation of cell membranes, hormones, and bile acids. People also ingest some cholesterol together with nourishments that comprise meat and milk products. Processed foods are also contributors to trans-fats that increase the levels of cholesterol in the body. Excess cholesterol constantly accumulates on the walls of the blood vessels. After a given period, it results in the development of plaque that narrows the blood vessels. If the accumulation of the cholesterol compounds occurs in the arteries that pump blood from the heart to the brain, an individual can experience a heart attack (Schatz et al., 2001).

Planning, implementation, and evaluation programs that are adopted from the tests and interventions to solve the health-related problems at both individual and community levels are termed evidence-based programs (Brownson, Fielding, & Maylahn, 2009). According to various studies that were conducted recently in public health services, there is likelihood that a majority of the people in developed nations such as America have high levels of blood cholesterol. The presence of high blood cholesterol can occur in both adults and children. This situation places them at a risk of developing high risks of heart attacks. Screening is now becoming more significant in promoting individual awareness of the dangers of cholesterol. The program is also viewed as easy, convenient, and affordable. The cholesterol-screening program is deemed easier due to the use of portable equipment that improves the process of measurement. The role of the health sector in the cholesterol-screening program is to conduct extensive research on the prevalence of the condition in addition to educating on its effects and ways of alleviation. The education targets not only the public and patients but also the healthcare professionals who further advocate for its treatment programs. The treatment program is done in either the hospital or home-based setups (Schatz et al., 2001).

Introduction of Evidence-Based Cholesterol Screening Programmes in Hospitals

Various epidemiological studies have indicated several factors that immensely contribute to diseases that are related to cholesterol. The screening programs ensure early detection of the cholesterol levels to reduce the likelihood of the onset and progression of cardiovascular diseases among others. Health practitioners have developed an interest in serum cholesterol due to its relationship with heart diseases and increased levels of total and low-density lipoprotein in the body. The cholesterol-screening program plays a critical role in the early detection, treatment, and prevention of the recurrence of the condition (Grundy et al., 2004). The results obtained from the program help the health practitioners provide the patients with the appropriate guidance and counseling tips.

The screening programs have been introduced in various health facilities based on the evidence of the magnitude of cholesterol-related problems amongst individuals. Various strategies have also been deployed to create the awareness of preventive measures, the effectiveness of treatment means, and the availability of various self-screening machines that are portable and considerably cheaper. The cholesterol-screening program is widely accepted due to its convenience, safety, user-friendliness, inexpensiveness, and its availability in most health care facilities (Grundy et al., 2004).

Various criteria used in cholesterol screening depend on the age at which the patient commences screening, the time between the check-up intervals, and duration of the program. It is suggested that the evaluation of cholesterol levels should be conducted. A report that was prepared by the United States Preventive Service Task Force recommended that cholesterol screening should begin at 35 years for men and 45 years for women. According to Antonopoulos (2002), testing cholesterol levels at tender ages can be risky.

The latest recommendations put forward by the Clinical Systems Improvement (ICS) show that it is ideal to conduct cholesterol screening starting at the age of 34 and 44 years for men and women respectively. In this case, the examination should be conducted after every five years. Screening at lower ages, especially 20-34 years for men and 20-44 years for women at frequent intervals should only be based on individual and health provider preferences. In Britain, the cholesterol measurement program is mandatory for adults who have attained 40 years and above. This strategy is a part of the risk assessment of opportunistic infections (Antonopoulos, 2002).

The knowledge about cholesterol screening has warranted the promotion of the program as an evidence-based practice to provide guidelines and recommendations on the appropriate care and life-changing behaviors for both individuals and the community. Various studies have also revealed a belief in the identification of people who are deemed the beneficiaries of the cholesterol screening intervention through diagnosis, improved therapy, and morbidity reduction among other aspects that are related to high levels of cholesterol in the body. This situation is made effective through cost-effective and scientifically proven screening approaches that are evidence-based.

Key Features of Cholesterol Screening Program

A successful cholesterol screening program involves a number of critical features that are explained below.

Achievable Foundational Planning

Prior to planning a cholesterol-screening program in the hospital set up, regulation or legislation concerning such action should be elaborated. The equipment intended for use must be in a good working condition. In addition, a Clinical Laboratory Improvement Amendments (CLIA) waiver must be in place to grant permission for the handling of blood samples. Policies supporting the screening should be enacted, especially the blood-borne pathogen control plan (Serxner, Gold, Anderson, & Williams, 2001). The screening programs should take into account the stakeholder preferences, available physicians and patients, and workflow schedules among others. In addition, the set program goals should be outlined clearly. They must relate to the budget allocations for the facility, patient care, pricing aspects, and marketing of the activity (Serxner et al., 2001).

Attributes of the Programme

The program structure must have the necessary equipment for measuring the cholesterol and fasting glucose levels. Others should include metabolic syndrome apparatus for determining the lipid and glucose levels, body mass index (BMI), and waist circumference among others (Serxner et al., 2001). Other factors that should be considered include the procurement and training of the staff to ensure that they conduct the screening program effectively. Equipment and staff must be certified via the Cholestech to ensure that they are competent. The specialists should provide the patients with an adequate education in the program, especially when the care testing devices are used. The patients should also be trained in dialogue techniques besides encouraging them to share their results with the healthcare providers (Serxner et al., 2001).

Required forms for screening should be availed to ensure that the health data is recorded appropriately. Patience privacy is paramount to the successful implementation of the screening program; hence, the stored information about their health status should be kept in safe places that can only be accessed by authorized personnel. A proper follow-up timetable is also a feature that must be included in the cholesterol-screening program. The information about the progress of the patient is important for monitoring individuals with critical metabolic syndromes. The follow-up schedule should be conducted physically or via phone calls to observe the patient’s conditions constantly for improvement (Serxner et al., 2001). Emergency cases require the caretakers and doctors to remain informed about the progress of the patients. Another aspect of follow-up is the establishment of consistent and ongoing healthcare for the screened patients (Serxner et al., 2001).

Compensation Procedures

Reimbursement routes must be clear. Either the patients or employer sponsoring the screening program conducts the procedures. A clear fee structure concerning charges of the cholesterol-screening program must be established. It can be formulated by conducting a competition analysis to compare various charges that are offered by laboratories. The duration of screening should also be considered, especially for screening sessions. A fair price is reached based on the market charges for such services and revenue targets. The patients must be issued with receipts that they should submit to the insurance companies. The practitioners must ensure the out-of-pocket cost reduction by encouraging the patients to access programs and policies that embrace affordable preventive methods such as medications, nutrition counseling, behavior support, community-based weight management programs, and gym membership among others. The patients must also be encouraged to follow expanded treatment coverage in the community and healthcare setups (Serxner et al., 2001).

Evidence-Based Strategies and Services in the Programme

On the creation of awareness and prevention strategies, the team-based interventions should guide the patients by establishing regular follow-up procedures that to monitor the patients’ progress. Besides, they should constantly educate them on cholesterol conditions, alleviation measures, adherence to medication, and behavior change (Serxner et al., 2001).

How Cholesterol Screening helps in the Re-Orientation of Health Services

The rapid increase in lifestyle diseases has heightened the need for screening programs for cholesterol-related conditions. Policymakers are forced to re-orient various health systems and services to address the demographic and epidemiological developments that are likely to increase the use of healthcare services thereby escalating the costs incurred by both the government and patients. Most health institutions must adapt to various health demands to meet the increasing needs for care services. The cholesterol-screening program can either be the hospital or home-based (Wise & Nutbeam, 2007). Another re-orientation of health care services is the decentralization of the services to ensure that the patients access the services in their homes among other reachable regions. The health sectors further re-orientate their systems to adapt long-term care services to accommodate patients with cholesterol-related problems (Wise & Nutbeam, 2007).

Cholesterol screening in hospitals has resulted in an increased number of visits to hospitals on daily and weekly basis. This situation ensures that the practitioners maintain constant communication with the patients with a view of ensuring health promotion. They act as advocates and educators to the patients; hence, they help them improve their lifestyles. Wise and Nutbeam (2007) reveal that well-structured health promotional programs such as cholesterol screening are run in contemporary healthcare institutions to detect, analyze, and formulate appropriate alleviation measures for heart diseases, smoking cessation, and diabetes among other cholesterol-related ailments. This situation ensures an increased awareness of the risk factors associated with such conditions. As a result, a need to adopt good and healthy lifestyles arises. The screening services in health setups have brought about the change and re-orientation of services. The healthcare providers consistently advise the patients on the adoption of diets and regular exercises to reduce the likelihood of experiencing increased cholesterol in the body among other lifestyle problems (Wise & Nutbeam, 2007). Numerous researchers in Europe attest that about 90 percent of people in the public domain support healthcare providers who constantly provide services such as cholesterol testing and screening and blood pressure monitoring among others. According to Wise and Nutbeam (2007), policymakers and healthcare practitioners have been encouraging people to monitor their health conditions by visiting the medical facilities to ensure that cholesterol levels are detected early for cost-effective treatment interventions. Most lifestyle diseases are eliminated since earlier detection of the risk factors helps in the control of cholesterol levels. The USA government is currently encouraging various healthcare systems to embrace the cholesterol screening health-promoting programs. Such services reduce the unplanned admissions by approximately 50 percent (Wise & Nutbeam, 2007).

Cholesterol screen programs have re-oriented the healthcare services to include complex medical services, improved consultations, and laboratory tests among others. Proper examination of the conditions is also upheld to promote the quality of therapeutic activities. In matters concerning legal persons, re-orientation of services includes the recording of files, consultations with labor medicine consultancies, and improved evaluation of occupational risks among others. Re-orientation is also evident where costing plans are included in the programs. The costs differ from one individual to the other depending on factors such as age, pathologic antecedents, and states of the patients under examination. Simpler and efficient plans are currently personalized to shorten the duration of the program to increase the treatment efficiency (Wise & Nutbeam, 2007).

The importance of cholesterol screening in the health service systems is the reduction of lifestyle conditions that result from behaviors such as increased alcohol consumption, intake of unhealthy diets, and sedentary life (Tabaei et al., 2003). Successful accomplishment of the plan leads to behavior change that has a significant health promotional effect on the patient. The realization of such benefits encourages the caregivers to ensure that self-efficacy beliefs are strengthened amongst the individuals with pathological issues (Wise & Nutbeam, 2007).

Critiquing the Cholesterol Screening as a Health Promotion Programme

Although the cholesterol-screening program is used in the elimination of lifestyle-related problems such as cardiovascular complications, many healthcare providers omit the follow-up activities that involve care, treatment, and counseling (Grol, 2001). A study that was conducted by Antonopoulos (2002) on a cholesterol-screening program indicated that about 50 percent of the patients who required further examination had to be followed after a period of one year as recommended by the NCEP. Another study that was conducted in the Texas High School to investigate the levels of cholesterol in students showed that their health caretakers followed up only 27 percent of the students who were identified with high levels of cholesterol for about 16 weeks (Mays, Ly, Allen, & Young, 2009).

Several studies have also indicated that cholesterol-screening tests are ineffective and inaccurate due to variability that exists between the test procedures and level of training of the healthcare givers. The training of such personnel varies from inexperienced to professional medical technologists. Most health practitioners rely on information obtained from the Internet instead of applying the screening statistical data collected from the local health centers. Each region has different health needs that vary each cholesterol-screening period. As a result, it is deemed inappropriate to consult with health practitioners who conducted cholesterol screening in the previous years. Therefore, the practitioners must be conversant with the information concerning the targeted groups (Mays et al., 2009).

There have been matters concerning incompetency among healthcare providers. In some cases, the practitioners lack adequate training in handling the cholesterol-screening equipment (Alpert, Greiner, & Hall, 2004). Other limitations of the cholesterol-screening program include the inability to guarantee protection. In addition, there has been evidence of false-positive results due to over-diagnosis and false negative due to the insensitivity of equipment. For this reason, the cholesterol screening program has is only applicable to risk reduction rather than offering a permanent solution (Expert Panel on Detection, 2001). There is also a false reassurance of various risks besides the overestimation of tests (Pearson et al., 2003). The laboratory tests being promoted positive feedback. As a result, the generation of false results can easily lead to false reassurance to the clients (Pearson et al., 2003).

The threshold of conducting the cholesterol screening and tests is arbitrary to pave a way for the determination of normality or further examination and medication of a condition. The National Health Screening Council for Volunteer Organisations (NHSCVO) provides several values that are higher than what a healthcare provider can use to determine if the condition warrants the commencement of a mediation process. For instance, the threshold of cholesterol valued at 360mg/dL and above is deemed high; hence, most physicians recommend values that are much lower (Myers et al., 2000). Some organization such as the American Heart Association (AHA) gives about 240mg/dL and above for patients with high cholesterol (Pearson et al., 2003). This situation leads to false-positive results that create a sense of insecurity in patients.

Other issues associated with the cholesterol-screening program include increased costs to the client who receives false-positive results. This situation can lead to unnecessary stress and treatment. The psychological effects on the wellbeing of the patient are not always visible since many people view the financial costs in the healthcare sector as low because most activities are based on volunteerism (Grol, 2001). Frequent referrals can lead to escalated expenses. The misleading results can cause psychological costs that are higher than the perceived benefits (Dulin, Olive, Florence, & Sliger, 2006). Criticism also arises due to the little information concerning the evidence of various benefits that arise from the cholesterol screening programs. The inadequate study available cannot lead to the generation of appropriate reports concerning the actual outcomes as it fails to highlight the definite number of patients who have been successfully examined by the health physicians. Furthermore, it is hard to maintain a record of their stages of health improvement in such cases. The pieces of literature only revolve around follow-up surveys with self-reported behaviors that are not related to the health results (Alpert et al., 2004).

Conclusion

The essay has elaborated the cholesterol-screening program as one of the health-promoting programs in the health systems. It has further highlighted various features of the program as well as its benefits to the re-orientation of healthcare services. Lastly, it has criticized the program for its limitations. Although the cholesterol-screening program has been embraced by many people including the healthcare practitioners as an effective method for identifying patients who are at higher risks of developing conditions that are related to cholesterol, there is limited information elaborating its efficacy. There is also limited information on the outcome of such conditions. There are minimal follow-ups considered by the healthcare practitioners and patients to ensure the administration of proper care and treatment partly due to costs. Therefore, the program is seen as a risk reduction strategy rather than a substitute for comprehensive patient care to promote the health of individuals. The patients are also at a risk of danger due to increased false negative and positive results. Nonetheless, the program is still useful in the determination of the cholesterol levels of individuals; hence, it should not be abandoned but should be used alongside other programs in ensuring a change of behavior of individuals who are at risk of developing non-communicable diseases.

Reference List

Alpert, J., Greiner, K., & Hall, S. (2004). Health fair screening: the clinical utility of the comprehensive metabolic profile. Family Medicine-Kansas City, 36(7), 514-519.

Antonopoulos, S. (2002). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation, 106(3143), 3421.

Brownson, R., Fielding, J., & Maylahn, C. (2009). Evidence-based public health: a fundamental concept for public health practice. Annual review of public health, 30(1), 175-201.

Dulin, M., Olive, K., Florence, J., & Sliger, C. (2006). The financial value of services provided by a rural community health fair. Journal of health care for the poor and underserved, 17(4), 821-829.

Expert Panel on Detection. (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on Detection, Evaluation, and Treatment of high blood cholesterol in adults (Adult Treatment Panel III). Jama, 285(19), 2486.

Grol, R. (2001). Successes and failures in the implementation of evidence-based guidelines for clinical practice. Medical care, 39(8), 11-46.

Grundy, S., Cleeman, J., Merz, C., Brewer, H., Clark, L., Hunninghake, D.,…Stone, N. (2004). Implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. Journal of the American College of Cardiology, 44(3), 720-732.

Mays, V., Ly, L., Allen, E., & Young, S. (2009). Engaging student health organisations in reducing health disparities in underserved communities through volunteerism: developing a student health corps. Journal of health care for the poor and underserved, 20(3), 914.

Myers, G., Kimberly, M., Waymack, P., Smith, S., Cooper, G., & Sampson, E. (2000). A reference method laboratory network for cholesterol: a model for standardisation and improvement of clinical laboratory measurements. Clinical chemistry, 46(11), 1762-1772.

Pearson, T., Bazzarre, T., Daniels, S., Fair, J., Fortmann, S., Franklin, B.,…Taubert, K. (2003). American Heart Association Guide for Improving Cardiovascular Health at the Community Level A Statement for Public Health Practitioners, Healthcare Providers, and Health Policy Makers From the American Heart Association Expert Panel on Population and Prevention Science. Circulation, 107(4), 645-651.

Schatz, I., Masaki, K., Yano, K., Chen, R., Rodriguez, B., & Curb, J. (2001). Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. The Lancet, 358(9279), 351-355.

Serxner, S., Gold, D., Anderson, D., & Williams, D. (2001). The impact of a worksite health promotion program on short-term disability usage. Journal of Occupational and Environmental Medicine, 43(1), 25-29.

Tabaei, B., Burke, R., Constance, A., Hare, J., May-Aldrich, G., Parker, S. A.,…Herman, W. (2003). Community-based screening for diabetes in Michigan. Diabetes Care, 26(3), 668-670.

Wise, M., & Nutbeam, D. (2007). Enabling health systems transformation: what progress has been made in re-orienting health services? Promotion & education, 14(2), 23-27.