Outcomes of an insurance company-sponsored multichannel chemistry screening initiative

BACKGROUND. The use of serum chemistry panels as screening tests has been studied in a variety of clinical and nonclinical settings. None of the studies, however, has attempted to carefully examine any potential harm done to participants, and none has measured the impact on health-related quality of life. METHODS. Consenting participants in an insurance company-sponsored screening initiative completed a questionnaire before and 6 months after having blood drawn for a 25-item chemistry panel and a lipid profile; for men older than 50, a prostate-specific antigen (PSA) test was also done. The prescreening questionnaire included demographic and health information. The postscreening questionnaire included questions about specific outcomes. Included in both questionnaires were single-item measures of self-rated health and self-rated worry about health, and the 17-item Duke Health Profile (DUKE), a measure of health-related quality of life. Various outcomes were examined, including the numbers of new diagnoses, numbers and types of new treatment recommendations, change in self-reported health and worry, and change in DUKE subscale scores. Participants who were potentially helped and those who were potentially harmed by the serum chemistry panels screening program were identified and further characterized. RESULTS. Of the 2249 subjects who satisfactorily completed both questionnaires, 2012 (89%) had at least one abnormal test result, but only 985 of these (49%) remembered having discussed their lest results with a physician. A total of 342 individuals received new treatment advice. However, 29 (10%) of them indicated that they would be "somewhat unlikely" to "very unlikely" to follow it. Following the intervention questionnaire, there were statistically significant average decrements in the General Health, Physical Health, and Pain subscales of the DUKE for participants with abnormal results. Self-rated health status did not change, but level of worry about health increased significantly. At least 250 (11%) subjects were potentially helped by the screening initiative, but at least 574 (26%) were potentially harmed by it. CONCLUSIONS. The use of serum chemistry panels as screening tests in nonclinical settings should probably be discouraged, since health-related quality of life is not improved and the intervention may harm more individuals than it benefits.