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Wellness testing: new opportunities for clinical labs.

The laboratory's role in preventive medicine will grow with testing to assess the individual's life-style environment and genetic makeup.

Wellness testing offers new opportunities for clinical laboratories to meet the challenge of preventive medicine. A large part of the challenge is to convince individuals that remaining well is worth the effort of a lifetime of good behavior-if you pay now, so to speak, you will reap the benefits later.

Most people want instant, tangible results. For example, if they

have a stomach ache, they know they can spend money for treatment or medication and get relief almost on the spot. Similarly, in laboratory testing on symptomatic patients, the results can be immediately applied to the existing problems.

In contrast, wellness testing requires a long-term perspective. Unfortunately, fees seem to be the only immediate aspect of weliness testing. Consequently it has been difficult to persuade some employers and hospitals to support prevention programs.

One analysis of the four major factors affecting wellness credits health care with the smallest impact, 10 per cent (see Figure 1). ' Tremendous opportunities lie ahead as clinical testing expands to assess the three other factors: life-style-which is rated the most important-environment, and genetic makeup. By the year 2000, clinical testing should make important contributions to the attack on disease at its roots rather than just helping physicians minister to its symptoms.

Even today, laboratories participating in the wellness movement provide standardized testing for screening, result confirmation, and monitoring of progress toward improved health (a common monitoring example is cholesterol testing after a few months of a low-fat diet combined with more exercise). Laboratorians also help provide wellness definitions, reference information, and risk assessment, and they participate in the public education process.

The authors are affiliated with a university science center and a for-profit reference laboratory (performing esoteric testing for clients in 47 states) established to support educational activities at the university. Clinical laboratories must often strike a balance between science and business. On the one hand, labs are businesses in a very competitive and rapidly changing environment. That hand is in the pocket guarding the funds. On the other hand-the hand reaching out to help-laboratory professionals are involved in research, teaching, and service activities aimed at optimizing health care.

Wellness testing can be consistent with both financial goals and technical missions, but lab professionals must maintain a balanced perspective.

The purpose of weliness programs is simple-to improve a population's overall state of health by decreasing mortality and morbidity. Weliness has become a national objective and the benefits of wellness programs are becoming widely recognized.

Threats to wellness are many: old age, coronary heart disease, cancer, hypertension, infection, metabolic disorders, nutritional inadequacy, substance abuse, environmental hazards, and poor life-style decisions. The risk of coronary heart disease can definitely be reduced through wellness activities. Life-style is within the individual's control and has a significant impact on health. Getting old is a fact, not an option, but improved health for the elderly is the consequence of wellness efforts undertaken earlier.

On the most intimate level, the family is critically important in promoting health and creating an environment in which wellness predominates. It is hard to take pleasure in celery when someone else in the household is eating chocolate cake. Healthful diet and exercise habits are best promoted in the home.

Government has assumed the role of a national protector, supporting preventive health programs . One of the Surgeon General's goals for 1990 is to have 60 per cent of the adult population in the U.S. participate in regular exercise. At the national level, antismoking campaigns, drug control, and cholesterol education are examples of wellness efforts making substantial advances.

AIDS is a prominent threat to the nation's health. If the spread of human immunodeficiency virus infection is not stemmed the cost of treating infectcd patients will ultimately fall to the Federal Government. More and more, reference labs like ours are performing HIV testing on patient specimens as well as blood products. Such testing can help control the spread of AIDS.

The most prevalent sponsors of wellness programs now are industrial firms wanting better health among employees and less absenteeism. Corporations, spending large sums to improve the health of their employees, are finding that wellness programs are costeffective.

Hospitals across the country are also setting up programs, to increase visibility and introduce more of the population to their services. Many health care professionals are leading the way as hospitals become involved in community wellness programs.

Before joining the wellness movement, laboratories need to carefully evaluate the claimed opportunities. Like motherhood and apple pie, weliness testing is hard to knock, and unfortunately, benefits are sometimes claimed without documentation. A glance at our references will give the reader some idea of programs whose benefits have been documented.

Mass screening for a specif'ic disease will succeed only when there is widespread public concern about the disease, when symptoms are recognizable, when the condition is treatable, and when testing gives a low incidence of false results. Overall, there must be some societal cost advantage to a health screening program; weliness testing will fail If it is perceived as unnecessary or wasteful.

Cancer prevention screening and health programs conclusively reduce health care costs .9 Cholesterol and pregnancy testing are now very popular. We predict that genetic tests for predisposition to disease, such as the ones based on DNA probe technologies, will be in demand, For example, instead of waiting for adult measurement of cholesterol, labs could help diagnose a child with familial hypercholesterolemia at birth, and therapy could begin immediately.

Workplace weliness programs can slow the escalating health care costs that have become a serious threat to the financial health of many corporations. From 1979 to 1983, hospitalization costs for employees in Johnson & Johnson's Live for Life program increased at only one-third the rate of a comparison group. ")

Corporate wellness programs are cost-beneficial in terms of insurance savings and lower absenteeism rates. Benefit/cost ratios from 2.1 to 5.5 have been reported-that is, for every dollar invested in employee wellness, $2.10 to $5.50 have been recovered in benefits to firms .

In 1987, our reference laboratory conducted a health fair for its employees and their families. Surveyed beforehand, 71 percent of the staff said they would benefit from a company-sponsored health program, and 69 per cent said they would participate.

Other institutions have reported similar results; a majority of people seem ready to do what they must to improve health. For example, J&J's Live for Life program grew from 2,000 employees at the start in 1979 to 75,000 worldwide in 1988. One year after completing the program of testing and life-style changes, participants had an average 8.4 per cent gain in maximal oxygen uptake. The increase continued to 10.5 per cent the second year. In comparison, a control group improved only 1.5 per cent after one year and 4.7 per cent after two years .

The Community Hypertension, Atheroscierosis, and Diabetes Study (CHAD) involved 2,500 individuals in a Jerusalem community between 197 1 and 1981. The family practice group studying the community found that both systolic and diastolic blood pressures were reduced significantly. Smoking decreased 7.2 per cent among men and 4.1 per cent among women. There were definite psychosocial benefits; participants who exercised regularly reported feeling better.

To successfully participate in the wellness movement, laboratories must adapt their operations to satisfy some major challenges:

*Avoid false-positive results.

False positives can lead to serious consequences for asymptomatic patients -e.g., blood donors tested for AIDS, and employees tested for illicit drug use. Because of the low prevalence of true-positive results in asymptomatic populations, screening tests have poor predictive value: For many such types of tests, 80 to 90 per cent of the positives will be false.

A dependable confirmation test is the only way to avoid reporting false results. Generally the same laboratories that screen will do the confirmation tests. Patients must understand the importance and necessity of confirming results with a different method.

* Satisfy legal as well as medical

demands. Certification, accredi tation, and licensure requirements for laboratories are dramatically changing to satisfy legal as well as clinical demands. The need for confidentiality in drug-of-abuse and AIDS testing has also affected laboratory operations, as have strengthened chain of custody procedures for drug testing. * Make a profit. The financial viability of laboratories will be scrutinized even more closely in the future; if our laboratories are not profitable businesses, they will be reorganized or closed. To succeed in wellness testing, labs will require expertise in marketing, sales, and finance.

A cautionary note is in order here. Wrong decisions about the way to set up and operate a wellness program cannot be righted by merely increasing testing. Without careful evaluation, labs may find themselves losing more money as they raise the volume of unprofitable assays.

Currently, wellness is a hot topic, as seen in the emerging variety of health newsletters, books, diet, and exercise health ranches designed to capture wellness dollars . In making weliness testing programs visible to the public, laboratories must provide accurate, comprehensible information, free of professional jargon.

Wellness testing gives laboratories an opportunity to do more than bring in added revenue. It enables them to further promote the quality, expertise, and true value of clinical testing, through increased interaction with the public, Reputable labs generally perform quality testing at a fair price. Cheaper prices, and less certain results, may be available from labs that cut corners.

Many laboratories are looking beyond their traditional clients toward wellness testing to bring in new business. Increased testing can result in more efficient use of instrumentation, space, and personnel. Higher test volume can further decrease the cost per test and increase profit, unless the resources required to generate the new business of the wellness market exceed the financial benefits. Weliness testing activities must be judiciously selected to be compatible with the capabilities and long-term plan of each laboratory.

In an article to appear soon in MLO, we will explain how lab management can set up successful weliness testing by carefully defining the lab's mission and market, evaluating resources, and developing a sound business plan.
COPYRIGHT 1989 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1989 Gale, Cengage Learning. All rights reserved.

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Author:Ash, K. Owen; Urry, Francis M.; Smith, Arthur M.
Publication:Medical Laboratory Observer
Date:Jun 1, 1989
Words:1696
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