Why baseline tests are the foundation of health and wellness for today’s patient base.
No single lab result has much meaning, other than in an acute care setting. For instance, in the emergency room critical lab data is used immediately for heart attack, stroke, diabetic coma, overdose and a number of other life-threatening conditions.
Stated in other terms, diagnosis, treatment and management of nearly any clinical condition requires the establishment of a patient baseline of test results. Once that baseline is established, clinicians typically follow results to determine whether a chronic health condition is more likely to occur later in life. So, these lab tests are used to initiate or modify a patient treatment program.
Yes, I’ve put that news out before, but let me put another consideration in play: there are several very good reasons a quiet group of Americans – the “unworried, unaware unwell” – need to be uncovered for their own good.
Introducing the ‘unworried, unaware unwell’
Before I explore this argument further, who exactly are the “unworried, unaware unwell”? This group could be defined several different ways, but my practical definition is those younger adults who do not display obvious symptoms of the early onset of a chronic disease, who also believe their life and health habits will preclude development of a chronic disease. These folks are most likely to exercise routinely, follow their fitness statistics using a wearable device, don’t smoke, drink moderately if at all and engage in healthy eating habits for the most part.
So, many of these folks have made the decision not to have routine physicals, clinician visits and probably have no clue of their baseline lab results. Theoretically, they should be a shining example for all of us. If we all took such good care of ourselves, everyone would lead longer, healthier lives, right?
If that were only true, but it’s not. So, what’s the problem? Well, there are 23 pairs of problems: their chromosomes. While we cannot change our eye color, hair color or most other physical characteristics, we also cannot control the underlying metabolic traits conferred by our genes. Some folks get the lucky genes and live long, relatively healthy lives regardless of their lifestyle. There are plenty of rock stars who are living proof of this. Others are living proof that sometimes bad things happen to good people. They develop a chronic disease or debilitating condition years before their peers, despite healthy life habits.
In this column, I intend to further explore the merits of physician visits and lab testing for the diseases that comprise the 10 leading causes of death in early adulthood, with routine monitoring of these conditions and why establishment of a baseline of lab results is so important.
The incidence of a couple of potentially very dangerous chronic conditions will serve to remind us that chronic diseases become more severe with age, but often display their first abnormal lab results much earlier. So, if you are a member of the “unworried, unaware unwell” or think you might know one, keep reading. What you read may help you or folks you know to get ahead of a chronic disease before it creates complications that may detract from your quality of life.
Hypertension statistics
For years, hypertension has been considered the “silent killer.” It has no overt symptoms, but undiagnosed, can lead to heart attack, stroke, kidney disease, blindness and death. It occupies a lofty place on the ten leading causes of death, involved in heart (No. 1), stroke (No. 5) and kidney disease (No. 10). It can easily be diagnosed at any age by a simple blood pressure test as part of a routine physical, with lab studies for lipids and metabolic panels as well as routine blood pressure measurements.
No biggie, right? Wrong. According to the CDC, nearly 116 million Americans have high blood pressure. That’s over one in three Americans. Worse yet, only 24% of adults with high blood pressure have it under control. Yeah, but hypertension is an old folks’ disease. Nope, not so. Twenty-two percent of adults between the ages of 18 and 38 have high blood pressure. In the 40-59 age group, it rises to 54.5%. So, you can jog, eat healthily, and check your stats on your wearable device, but you cannot outrun the statistics.
Even the “unworried, unaware unwell” need routine health care visits with blood pressure checks and routine lab results. Surely, their commitment to a healthy lifestyle brings them into physician offices frequently. Not so much. From the age of 10 all the way up to 54, the average American visits a primary care physician once or fewer annually. The earlier age group data is skewed by school physicals, and data for older groups includes pre-employment screening. So, in the real world, this group continues to feel as if they have no need for routine healthcare visits.
Diabetes statistics
Let’s assume your “unworried, unaware unwell” friend has dodged the hypertension bullet. Unlikely considering the statistics, but let’s make that assumption. Are they in the clear? Not really.
Diabetes, especially type 2, is on the rise and is often a comorbidity with hypertension. The CDC estimates 96 million prediabetic Americans are walking alongside of 37 million already diagnosed. That’s a total of 134 million Americans, more than the number of hypertensives mentioned earlier. Diabetes ranks No. 8 on the list of leading causes of morbidity and mortality and is associated with nearly 50% of all deaths and disability in America. While that may be true, it’s just for folks with poor health habits and older folks, right? Not so fast. Eating habits and lack of exercise are factors for sure, but genetic predisposition plays a role. And age is not a defining factor. Of 1.5 million Americans diagnosed with diabetes in 2017, one-third were adults under the age of 44. Youth is not an absolute protection against diabetes.
What are the implications of this data?
First, it’s very clear that routine health care visits, with quality vital signs measurements and routine lab results including baselines at an early age are sentinels that can make every American aware of their baseline readings for critical health indicators. Hopefully, it is now also clear that while age and taking responsibility for a healthy lifestyle can make a difference, they are no guarantee against development of a chronic condition, even early in life.
Thoughts on solutions
Awareness of the need to have an annual healthcare visit is an important element to improving individual health outcomes and those of the American public at large, but they are only part of the solution. Some Americans are hampered by either financial concerns or live in areas where access to healthcare is limited compared to more affluent urban and suburban communities. Solutions to these challenges are well beyond the capabilities of the average American, but those of us with a choice need to opt for routine healthcare visits and establishment of a baseline of our healthcare data. As I have learned from personal experience, reviewing your wearable device statistics on your phone is no substitute for healthcare visits.
As mentioned above, there is a certain level of denial among the younger, more fit population that contributes to reluctance to engage in routine healthcare visits and lab results. What about these folks? It is my opinion that the expanding range of healthcare options including community clinics, urgent care centers and retail convenience clinics can and should play a role here. In the recent past, a national retail clinic chain developed a program to offer hemoglobin A1c testing on a walk-in basis. Unfortunately, it received a lukewarm reception from the public. Based on a deeper understanding of the statistics available to us, I wonder whether it is time to re-address this option. There is no question that earlier diagnosis can lead to earlier intervention. In addition, diabetes is increasing rapidly, and the U.S. life expectancy statistics have tumbled since COVID and have responded more slowly than in other developed countries. It would be interesting to see whether a combination of education and awareness at readily available clinical settings along with fast, inexpensive blood pressure and hemoglobin A1c testing could provide an improvement in earlier detection of serious chronic diseases, improving duration and quality of life.
Which tests are being recommended by Medicare and United States Preventive
Services Task Force?
Setting aside the dream state of a large-scale program to screen Americans to diagnose chronic conditions early, as appealing as it may be, what options are currently available?
Medicare pays for:
- An annual wellness visit with an assessment of physical and cognitive health that MAY include lab tests.
- MOST lab tests are covered by Medicare based on physician prescription.
- Medicare offers a diabetes prevention program which includes weekly group meetings, hemoglobin A1c testing and body mass assessment.
- HIV and Hepatitis C testing are also covered for eligible Medicare recipients.
- Eligible patients should discuss options with their healthcare provider to learn more.
USPSTF testing recommendations:
- Many of these screening tests are for specific risk groups
- Blood pressure screening
- Prediabetes screening
- Urinary tract infection testing during pregnancy
- HPV/PAP tests for cervical cancer
- Chlamydia/Gonorrhea testing (at-risk individuals)
- HIV, syphilis, and HCV screening (at-risk individuals)
- Tuberculosis screening (at-risk individuals)
- Colorectal cancer screening (age-related and risk-related)
- Drug screening (at-risk individuals)
Bottom line: in our role as consultants, we are often asked to recommend which lab tests our customers should offer. But, do we take the proactive step to recommend who and when to test? We may feel this is out of our responsibility level and that some of our customers may consider we are overstepping our bounds. Engaging in these sorts of conversations can lead to some interesting discussions that can cause at least some of our customers to take more active steps to screen their patients. I think it’s worth it for us and our customers. We establish or reinforce our value as forward-thinking consultants. Our caregiver customers receive information that can and likely will make a difference in the health of their patients. That first step to have baseline tests performed is a small investment. It takes less time than a sit-down dinner, concert or even our daily fitness walk but can pay significant dividends down the road. It’s worth thinking about how we can impact the lives and health of the “unworried, unaware unwell.”