[A prospective study of access to medical services following a community-based screening program]

Participants in a multiphasic screening program, 454 men and 767 women, were followed up for a period of several months (117 days on the average) in order to evaluate their needs for medical services after screening. Five hundred sixty-two (47.1%) visited outpatient clinics in the study area; 185 as continuing visits for existing diseases (prevalent), 167 because of symptoms which developed after the screening (clinical), and 65 for further investigations of abnormal findings from the screening (screened). The ratio of prevalent to incident (= clinical + screened) cases, which is related to the duration of clinical phase, was the highest in hypertensive, thyroid, ophthalmologic disorders. This indicates that health services for prevalent cases of those diseases are needed in addition to primary and secondary preventive efforts. The proportion of screened cases in the incident cases, which reflects the ability of the screening program to detect diseases in the preclinical phase, was the highest for anemia, disorders of lipid metabolism, and hypertensive disorders. The smaller proportions in dermatologic, urologic and orthopedic disorders indicate that preventive methods for these disorders should be considered in the future. In conclusion, monitoring of screening participants by prospective follow-up and analysis by two measures proposed in this study seem promising for continuing evaluation of the effectiveness of an on-going screening program. A network system of hospitals and physicians' offices should be developed, by which the information on the visits to outpatient clinics after screening is collected and analyzed periodically for monitoring.