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| Quality Assurance in General Practitioners (BE QUICK - Benchmarking Quality Assurance In Clinical Practice for Hong Kong) |
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Preventive Care Audit Manual |
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PDF download (Word download) |
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2. Screening Criteria A major part of a preventive program is concerned with screening for diseases. Certain criteria should be observed for such screening. Below is a summary adapted from the First Report of the National Screening Committee, Health Department of UK, April 1998 and from the Principles and Practice of Screening for Disease by JMG Wilson & G. Junger 1968. Geneva: WHO. 2.1. The Condition - The condition should be important in terms of its significant effect on the quality or quantity of life. - The condition should be common enough to justify the cost of screening. - The epidemiology and natural history of the condition, including the development from latent to declared disease, should be known and there should be a detectable risk factor, disease marker, latent period, or early asymptomatic stage. - The condition must be treatable when it is detected early. 2.2. The Test - The test should be simple and safe without causing any harm to the patient. - The test should be acceptable to the patient or the population to be tested. - The test should be precise and valid. The positive predictive value of the test depends not only on the sensitivity and specificity but also on the prevalence of the disease. - The distribution of the test values in the target population should be known and a suitable cut off level be defined and agreed. - Adequate facilities for performing the screening tests must be available. - There should be an effective policy on how to manage a positive result so that adequate choices or options are available to the individuals tested. 2.3. The Treatment - A cost effective treatment should be available for patients identified through early detection. - There should be good evidence that early treatment of the condition would lead to better outcomes than late treatment. - The treatment should be safe and acceptable to the patient. - Facilities for treatment should be available in the community. 2.4. The Screening Program - There should be evidence from high quality Randomized Control Trials (RCT) that the screening program is effective in reducing the mortality or morbidity of the condition being screened. - There should be evidence that the complete screening program (test, diagnostic procedures, treatment/intervention) is clinically, socially, and ethically acceptable to health professionals and the public. - The benefit from the screening program should outweigh the physical and psychological harm caused by the tests, diagnostic procedures and treatments. - The cost of case finding by the screening program should be economically balanced in relation to the possible expenditure on medical care as a whole. - There should be a plan for managing and monitoring the screening program and an agreed set of quality assurance standards. - Adequate staffing and facilities for testing, diagnosis and treatment, |