Evolution of multiple disease screening in Keelung: A model for community involvement in health interventions?

Po En Wang, Ting Ting Wang, Yueh Hsia Chiu, Amy Ming Fang Yen, Tony Hsiu Hsi Chen

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: Screening for cancer and other chronic conditions tends to be conducted in independent programmes; that is, screening for one disease at a time. The Keelung community-based multiple disease screening programme, developed in Keelung city, Taiwan, is a notable exception. Here, we report on the Keelung programme's ethos and development within the community, focusing on equity of delivery of the service, and community involvement. In addition, we present some preliminary cost-effectiveness analyses of multiple disease screening. Methods: The Keelung programme offers screening for breast, colorectal and liver cancers, cervical and oral neoplasia, all of which have an evidence base for their efficacy, and for diabetes, hypertension, osteoporosis and hyperlipidaemia, which are of unknown efficacy. We assessed variability of coverage rates of the Keelung Community-based Integrated Screening (KCIS) programme with age and socioeconomic status, availability of facilities for referral of positive screenees, and numbers of community social workers, general practitioners and local hospitals involved in the programme. We also assessed in qualitative terms how the programme interacts with non-health agencies. Finally, we simulated activities and costs for a variety of single- and multiple-disease screening situations. Results: Between 1999 and 2003, coverage increased overall from 14.7 to 34.4%, and increased most dramatically in people aged 60-79 years (from around 30 to 60%) and in those of lower educational status (from around 40 to 70%). There was a significant growth in the involvement of social workers and volunteers in the programme, and an increase in the availability of local diagnostic and care facilities for those screened positive. In addition, there was substantial involvement of non-health agencies in publicizing the programme. In the health economic simulations, compared with no screening, the extra costs to gain an additional life year were estimated as US$667, $608, $4227 and $4789 for multiple screening with 100% attendance, multiple screening with 70% attendance, single disease screening with 100% attendance and single disease screening with 30% attendance at each programme (i.e. 74% attendance for at least one out of four programmes), respectively. Conclusions: The innovative design and outreach procedures of the KCIS have led to a growth in delivery of screening services to groups sometimes overlooked (equity), community involvement in health care (participation) and the use of non-health organizations for publicity and health education (collaboration). Simulation studies indicate that multiple disease screening may be more cost-effective than single disease screening.

Original languageEnglish
JournalJournal of Medical Screening
Volume13
Issue numberSUPPL.1
Publication statusPublished - Dec 2006
Externally publishedYes

Fingerprint

Health
Costs and Cost Analysis
Educational Status
Community Participation
Mouth Neoplasms
Liver Neoplasms
Growth
Hyperlipidemias
Taiwan
Early Detection of Cancer
Health Education
Social Class
General Practitioners
Osteoporosis
Cost-Benefit Analysis
Volunteers
Colorectal Neoplasms
Referral and Consultation
Economics
Organizations

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy

Cite this

Evolution of multiple disease screening in Keelung : A model for community involvement in health interventions? / Wang, Po En; Wang, Ting Ting; Chiu, Yueh Hsia; Yen, Amy Ming Fang; Chen, Tony Hsiu Hsi.

In: Journal of Medical Screening, Vol. 13, No. SUPPL.1, 12.2006.

Research output: Contribution to journalArticle

Wang, Po En ; Wang, Ting Ting ; Chiu, Yueh Hsia ; Yen, Amy Ming Fang ; Chen, Tony Hsiu Hsi. / Evolution of multiple disease screening in Keelung : A model for community involvement in health interventions?. In: Journal of Medical Screening. 2006 ; Vol. 13, No. SUPPL.1.
@article{7e8e53e946c94b5f872e9eb8a191c46b,
title = "Evolution of multiple disease screening in Keelung: A model for community involvement in health interventions?",
abstract = "Objective: Screening for cancer and other chronic conditions tends to be conducted in independent programmes; that is, screening for one disease at a time. The Keelung community-based multiple disease screening programme, developed in Keelung city, Taiwan, is a notable exception. Here, we report on the Keelung programme's ethos and development within the community, focusing on equity of delivery of the service, and community involvement. In addition, we present some preliminary cost-effectiveness analyses of multiple disease screening. Methods: The Keelung programme offers screening for breast, colorectal and liver cancers, cervical and oral neoplasia, all of which have an evidence base for their efficacy, and for diabetes, hypertension, osteoporosis and hyperlipidaemia, which are of unknown efficacy. We assessed variability of coverage rates of the Keelung Community-based Integrated Screening (KCIS) programme with age and socioeconomic status, availability of facilities for referral of positive screenees, and numbers of community social workers, general practitioners and local hospitals involved in the programme. We also assessed in qualitative terms how the programme interacts with non-health agencies. Finally, we simulated activities and costs for a variety of single- and multiple-disease screening situations. Results: Between 1999 and 2003, coverage increased overall from 14.7 to 34.4{\%}, and increased most dramatically in people aged 60-79 years (from around 30 to 60{\%}) and in those of lower educational status (from around 40 to 70{\%}). There was a significant growth in the involvement of social workers and volunteers in the programme, and an increase in the availability of local diagnostic and care facilities for those screened positive. In addition, there was substantial involvement of non-health agencies in publicizing the programme. In the health economic simulations, compared with no screening, the extra costs to gain an additional life year were estimated as US$667, $608, $4227 and $4789 for multiple screening with 100{\%} attendance, multiple screening with 70{\%} attendance, single disease screening with 100{\%} attendance and single disease screening with 30{\%} attendance at each programme (i.e. 74{\%} attendance for at least one out of four programmes), respectively. Conclusions: The innovative design and outreach procedures of the KCIS have led to a growth in delivery of screening services to groups sometimes overlooked (equity), community involvement in health care (participation) and the use of non-health organizations for publicity and health education (collaboration). Simulation studies indicate that multiple disease screening may be more cost-effective than single disease screening.",
author = "Wang, {Po En} and Wang, {Ting Ting} and Chiu, {Yueh Hsia} and Yen, {Amy Ming Fang} and Chen, {Tony Hsiu Hsi}",
year = "2006",
month = "12",
language = "English",
volume = "13",
journal = "Journal of Medical Screening",
issn = "0969-1413",
publisher = "SAGE Publications Ltd",
number = "SUPPL.1",

}

TY - JOUR

T1 - Evolution of multiple disease screening in Keelung

T2 - A model for community involvement in health interventions?

AU - Wang, Po En

AU - Wang, Ting Ting

AU - Chiu, Yueh Hsia

AU - Yen, Amy Ming Fang

AU - Chen, Tony Hsiu Hsi

PY - 2006/12

Y1 - 2006/12

N2 - Objective: Screening for cancer and other chronic conditions tends to be conducted in independent programmes; that is, screening for one disease at a time. The Keelung community-based multiple disease screening programme, developed in Keelung city, Taiwan, is a notable exception. Here, we report on the Keelung programme's ethos and development within the community, focusing on equity of delivery of the service, and community involvement. In addition, we present some preliminary cost-effectiveness analyses of multiple disease screening. Methods: The Keelung programme offers screening for breast, colorectal and liver cancers, cervical and oral neoplasia, all of which have an evidence base for their efficacy, and for diabetes, hypertension, osteoporosis and hyperlipidaemia, which are of unknown efficacy. We assessed variability of coverage rates of the Keelung Community-based Integrated Screening (KCIS) programme with age and socioeconomic status, availability of facilities for referral of positive screenees, and numbers of community social workers, general practitioners and local hospitals involved in the programme. We also assessed in qualitative terms how the programme interacts with non-health agencies. Finally, we simulated activities and costs for a variety of single- and multiple-disease screening situations. Results: Between 1999 and 2003, coverage increased overall from 14.7 to 34.4%, and increased most dramatically in people aged 60-79 years (from around 30 to 60%) and in those of lower educational status (from around 40 to 70%). There was a significant growth in the involvement of social workers and volunteers in the programme, and an increase in the availability of local diagnostic and care facilities for those screened positive. In addition, there was substantial involvement of non-health agencies in publicizing the programme. In the health economic simulations, compared with no screening, the extra costs to gain an additional life year were estimated as US$667, $608, $4227 and $4789 for multiple screening with 100% attendance, multiple screening with 70% attendance, single disease screening with 100% attendance and single disease screening with 30% attendance at each programme (i.e. 74% attendance for at least one out of four programmes), respectively. Conclusions: The innovative design and outreach procedures of the KCIS have led to a growth in delivery of screening services to groups sometimes overlooked (equity), community involvement in health care (participation) and the use of non-health organizations for publicity and health education (collaboration). Simulation studies indicate that multiple disease screening may be more cost-effective than single disease screening.

AB - Objective: Screening for cancer and other chronic conditions tends to be conducted in independent programmes; that is, screening for one disease at a time. The Keelung community-based multiple disease screening programme, developed in Keelung city, Taiwan, is a notable exception. Here, we report on the Keelung programme's ethos and development within the community, focusing on equity of delivery of the service, and community involvement. In addition, we present some preliminary cost-effectiveness analyses of multiple disease screening. Methods: The Keelung programme offers screening for breast, colorectal and liver cancers, cervical and oral neoplasia, all of which have an evidence base for their efficacy, and for diabetes, hypertension, osteoporosis and hyperlipidaemia, which are of unknown efficacy. We assessed variability of coverage rates of the Keelung Community-based Integrated Screening (KCIS) programme with age and socioeconomic status, availability of facilities for referral of positive screenees, and numbers of community social workers, general practitioners and local hospitals involved in the programme. We also assessed in qualitative terms how the programme interacts with non-health agencies. Finally, we simulated activities and costs for a variety of single- and multiple-disease screening situations. Results: Between 1999 and 2003, coverage increased overall from 14.7 to 34.4%, and increased most dramatically in people aged 60-79 years (from around 30 to 60%) and in those of lower educational status (from around 40 to 70%). There was a significant growth in the involvement of social workers and volunteers in the programme, and an increase in the availability of local diagnostic and care facilities for those screened positive. In addition, there was substantial involvement of non-health agencies in publicizing the programme. In the health economic simulations, compared with no screening, the extra costs to gain an additional life year were estimated as US$667, $608, $4227 and $4789 for multiple screening with 100% attendance, multiple screening with 70% attendance, single disease screening with 100% attendance and single disease screening with 30% attendance at each programme (i.e. 74% attendance for at least one out of four programmes), respectively. Conclusions: The innovative design and outreach procedures of the KCIS have led to a growth in delivery of screening services to groups sometimes overlooked (equity), community involvement in health care (participation) and the use of non-health organizations for publicity and health education (collaboration). Simulation studies indicate that multiple disease screening may be more cost-effective than single disease screening.

UR - http://www.scopus.com/inward/record.url?scp=34247267670&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247267670&partnerID=8YFLogxK

M3 - Article

C2 - 17227644

AN - SCOPUS:34247267670

VL - 13

JO - Journal of Medical Screening

JF - Journal of Medical Screening

SN - 0969-1413

IS - SUPPL.1

ER -