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Health Spotlight


Immunizations and Screenings

a man receiving a medical examination

An Ounce of Prevention: Stay Healthy with Regular Screenings

It's true: An ounce of prevention really can go a long way toward maintaining good health. One important part of staying healthy is to get regular screening tests and immunizations. A screening is a test or exam designed to detect a condition or disease1, while an immunization is usually a shot or injection that helps protect people from contracting a disease by boosting the immune system2.

Some common screening exams can include:

  • blood tests (to detect diseases like diabetes or check cholesterol levels)
  • physical exams (such as hearing tests, prostate exams, mammography or colonoscopy)
  • detailed health history

Related Resources

Immunizations are another important preventive health measure. While many immunizations are given between the ages of six months and three years, there are some adult immunizations3 that offer additional protection, including:

  • meningococcal vaccine
  • pneumococcal vaccine
  • herpes zoster vaccine

About Screenings and Immunizations

In order to establish immunization and screening guidelines, the Centers for Disease Control and Prevention (CDC) and the United States Preventive Service Task Force (USPSTF) regularly evaluate screening and immunization research and effectiveness4. New guidelines are issued annually, so to learn what's right for you, talk with your doctor. You can also learn more about the most recent screening guidelines and immunization schedules by visiting the CDC or USPSTF websites.

HSR&D Research

One of the biggest challenges with screenings and immunizations is determining how often certain tests should be conducted, or which immunizations might be most effective. Physicians and other healthcare providers can guide their patients about what screening and immunization schedule is best; however, patients who are veterans often have conditions that require more frequent screenings, or an adjusted recommended immunization schedule. VA has made a priority of funding research studies that focus on screenings and immunizations. Here are a few examples of that research.

Screening for Diabetic Retinopathy Using Telemedicine

Diabetic retinopathy is a serious eye disease that, untreated, can lead to blindness5. Tight control of blood sugar and regular eye exams are an important part of preventing and detecting the condition. However, many veterans with diabetes do not get regular screening eye exams. Researchers at the VA Boston Medical Center are currently conducting a study6 to determine if tele-retinal imaging can be used to enhance the rates of screening in veterans at risk for diabetic retinopathy and other eye conditions, such as glaucoma and cataracts. Investigators are hoping that this process-Technology Assisted Ophthalmic, or TAO-can serve as an alternative to a complete eye exam in patients with diabetes.

Participants will have a TAO and a complete eye exam, and investigators will assess the correlation between the two. They will then follow patients with no or mild retinopathy over a two-year period, with exams every 12 months using both TAO and complete eye exams. Results will determine whether TAO and a complete eye exam concur in their assessment for both retinopathy and other eye diseases, and how the two methods compare with regard to referrals, sensitivity, and specificity. Investigators have enrolled 500 participants in the study, which is expected to conclude in 2010. The study may have a valuable impact on improving eye disease screening rates for veterans with diabetes.

Improving HIV Screening with Streamlined Counseling and Rapid Testing7

As the Centers for Disease Control and Prevention (CDC) have estimated, 25% of more than one million patients who are infected with the human immunodeficiency virus (HIV) in the United States are unaware of their diagnosis. HIV testing is cost-effective, yet testing rates among those at risk remain low due to several key factors: access to testing, lack of follow-up on the part of the patient to retrieve test results, and wait times for test results. Each year, approximately 20,000 veterans receive HIV care through the Veterans Health Administration (VHA), making VHA the largest single provider of HIV care in the US.

In this study, investigators evaluated three screening models that incorporated same-day HIV rapid-testing, streamlined counseling, and nurse-initiated screening. Investigators assessed rates of HIV testing and receipt of results, sexual risk reduction, and improvement in HIV knowledge among 251 veterans with primary/urgent care appointments at two VA clinics in the same city. Findings show that the model using streamlined counseling in conjunction with rapid testing significantly increased testing and result receipts over current practice. Because HIV treatment is highly cost-effective in early intervention, routine HIV screening that provides fast, easy access to results is of considerable value within VA.

Improving Influenza and Pneumococcal Vaccination Rates

Recent research has shown that veterans with spinal cord injury are almost 40 times more likely to die from flu or pneumonia than comparable individuals in the general public. Since immunization is critical in helping prevent flu and pneumococcal pneumonia, VA researchers studied methods8 to increase immunization rates in veterans with spinal cord injury.

In this study, which was concluded in 2005, investigators used a multi-strategy approach that targeted patients, investigators, and the VA healthcare system. Patients received personalized mailings and reminders; clinical reminders were used in facilities; and practitioners received educational materials and reminders to vaccinate and education their patients.

The study resulted in steady increase in vaccination rates during the course of the investigation, and the intervention was both sustainable and effective. The impact of this study has resulted in a system-wide change that has increased the overall rate of flu and pneumonia vaccinations for veterans with spinal cord injury.

References

  1. Venes, D. et. al. Taber's Cyclopedic Medical Dictionary 19E, p. 1859. (F.A. Davis, Philadelphia, PA. 2001.)
  2. Ibid, p.1023
  3. United States Department of Health & Human Services' National Women's Health Information Center website: http://www.4woman.gov/screeningcharts
  4. Centers for Disease Control & Prevention website: http://www.cdc.gov/vaccines/; United States Preventive Services Task Force website: http://www.ahrq.gov/clinic/pocketgd.htm
  5. Venes, D. et. al. Taber's Cyclopedic Medical Dictionary 19E, p. 1799. (F.A. Davis, Philadelphia, PA. 2001.)
  6. Clinical and Cost Effectiveness of Screening for Diabetic Retinopathy Using Tele-Ophthalmology. Conlin, P. MD. Boston VA Medical Center, Boston, MA. (January 2006 - December 2010)
  7. Improving HIV Screening by Nurse Rapid testing, Streamlined Counseling. Asch, S. MD. VA Greater Los Angeles Healthcare System, Los Angeles, CA. (January 2005 - January 2007)
  8. Increasing Influenza and Pneumococcal Vaccination in the VA SCI&D Population. Weaver, F. PhD. Edward Hines, Jr. VA Hospital, Hines, IL. (April 2002 - September 2005)