Screening and Counseling 

Screening is testing for a disease or condition in persons who have no symptoms or signs 

of the disease. Screening is particularly important for many diseases that respond well to 

early treatment, such as breast, cervical, and colorectal cancer, HIV, diabetes, 

osteoporosis, depression, alcohol misuse, and tobacco use. Public health officials, 

physicians, and disease advocacy groups have worked hard to persuade Americans about 

the importance of screening, and most Americans have become true believers. For 

example, one study showed that most adults (87%) feel that routine cancer screening is 

almost always a good idea and that finding cancer early saves lives (74%).1 However, 

there is a growing recognition among medical professionals that while some individuals 

may benefit from early detection, others may be diagnosed and treated for cancer 

unnecessarily.2 In some cases, screening may not be enough and follow-up counseling 

may be required to assist patients with treatment adherence. 

Recent HSR&D studies provide evidence about screening in a number

of clinical areas: 

» HIV Screening 

Testing for HIV has been shown to be cost-effective, yet rates of testing remain low. 

However, a recent VA/HSR&D study shows promising results on rapid testing for HIV. 

Rapid testing most often involves an oral swab and results can be available in 20 minutes,

compared to traditional HIV testing that involves two appointments – one for testing and 

another several days later to receive results and HIV counseling. In this study of 189 

veterans seen at VA primary/urgent care clinics in West Los Angeles, 92.1% of the 

veterans took the rapid HIV test, and 82.5% collected their results compared to 40.3% 

who received the usual test with just 16.1% collecting their results. Thus, rapid HIV 

testing greatly increased both testing and receipt of results. Rapid testing shows promise 

for lessening the spread of the virus and increase early treatment and better outcomes for

veterans with HIV.3

» Alcohol and Tobacco Screening and Counseling 

The National Commission on Prevention Priorities recently ranked tobacco and alcohol 

counseling in the top 10 US prevention priorities based on clinically preventable burden 

and cost-effectiveness, with tobacco counseling tied for the highest priority. However, 

most patients who smoke or misuse alcohol do not receive these important services. In 

order to implement evidence-based tobacco and alcohol counseling, it is essential to have 

adequate measures to identify the target population and monitor care provided.4 HSR&D 

investigators studied alcohol screening and found that 93% of VA outpatients were 

screened for alcohol misuse. While 25% of veterans screened positive, only 42% had 

follow-up that included brief alcohol counseling. As a result, study investigators are 

proposing a national performance measure for brief alcohol counseling following a positive

screen for alcohol misuse.5

Read past HSR&D

Management e-Briefs on 

the HSR&D website. 

 

This Management e-Brief 

is provided to inform you 

about recent HSR&D 

findings that may be of 

interest. The views 

expressed in this 

article are those of 

the authors and do 

not necessarily reflect 

the position or policy 

of the Department of 

Veterans Affairs. If 

you have any questions 

or comments about this 

Brief, please email 

CIDER at 

CIDER.Boston@va.gov. 

The Center for 

Information 

Dissemination and 

Education Resources 

(CIDER) is a VA HSR&D 

Resource Center charged 

with disseminating 

important HSR&D 

findings and information 

to policy makers, 

managers, clinicians, 

and researchers working 

to improve the health 

and care of veterans. 

1
For tobacco, guidelines recommend that providers do the 5 "A"s – Ask, Advise, Assess, 

Assist, and Arrange follow-up. VA performance measures focused initially on ensuring that 

patients were asked about tobacco use and that users were advised to quit. Nationally, 

and for several years, performance on these measures has been more than 90%. The 

success at asking and advising about smoking has led to the development of new 

performance measures that are planned to begin in 2007. The new measures will focus on 

"assisting smokers" and will assess whether they are offered counseling and/or 

medications to help them quit.4

1. Schwartz L, Woloshin S, Fowler F, and Welch G. America's Enthusiasm for Cancer Screening. Journal of the American Medical

Association 2004;Jan 7;291(1):71-78. 

2. Kingsinger L. Screening: Balancing the Benefits and Harms. FORUM May, 2006 

www.hsrd.research.va.gov/publications/forum/ 

3. Anaya H, Asch S, Hoang T, et al. Improving HIV screening with rapid testing and streamlined counseling. Presented at the 

XVI International AIDS Conference, Toronto, Canada, August 13-18, 2006. 

4. Bradley K and Sherman S. Measuring quality of care for smoking and alcohol misuse counseling in the VA. SGIM FORUM 

September 2006;29(9)7. Published by the Society of General Internal Medicine. 

5. Bradley K, Williams E, Achtmeyer C, et al. Implementation of evidence-based alcohol screening in the Veterans Health 

Administration. American Journal of Managed Care October 2006;12(10):597-606. 

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