Pharmacy in Public Health Levels of Disease Prevention

Pharmacy in Public Health: Levels of Disease Prevention Add course Date here

Learning Outcomes • Compare and contrast disease prevention with health promotion. • For each level of prevention, list the target population, goals, and the types of interventions used to reach those goals. • Describe types of primary, secondary, and tertiary interventions for disease prevention at the individual, community, and national or international level. • Give examples of activities performed by pharmacists that demonstrate involvement at the three levels of prevention.

Disease Prevention Overview • Prevention is a cornerstone concept in public health – If it cannot be prevented, try to reduce its impact • Often tailored to a specific disease or risk • Prevention may occur at individual or population levels

Health-to-Death Continuum • Think about various levels of healthiness, sickness, and death – Activities to reduce disease and increase health by where they are initiated on the continuum Figure 9. 1

Relationship between Continuum and Health Promotion & Disease Prevention • Health Promotion – optimize overall health. LEFT side • Disease Prevention – reduce occurrence and impact of specific diseases. RIGHT side Figure 9. 2

Three Levels of Prevention Define levels by: • • • Goal Rationale Target population Typical activities Outcome measure Late Disease Early Disease Exposed / risk factors Whole population

Primary Prevention • Goal: • Reduce number of new cases • Rationale: • By reducing exposure rates and increasing resistance, can reduce number of new cases • Target population: • Those who are most likely to be exposed and/or could increase their resistance • Typical activities: • Remove or reduce source of the risk • Educate and make aware of disease risk – Include behavioral changes to reduce exposure • Improve general health • Outcome measure: incidence of exposure; incidence of disease

Secondary Prevention • Goal: • Reduce number of new cases; reduce number of severe cases • Rationale: • By reducing number of exposures and early disease that progress to more severe disease, mortality and morbidity can be reduced • Target population: • Those who have been exposed to the disease-causing agent or have early symptoms of the disease • Typical activities: • Screening for exposure and/or disease • Post-exposure prophylaxis • Early treatment to reduce impact of disease/reverse course • Outcome measure: incidence of disease

Tertiary Prevention • Goal: • Reduce number of complications, deaths • Rationale: • By reducing disease severity and increasing recovery, can reduce number of premature deaths or complications • Target population: • Those who have disease and need treatment • Typical activities: • Treatment tailored to the patient • Rehabilitation to promote recovery • Outcome measure: incidence of death and longterm disability

Levels of Prevention Table 9. 1 Pharmacy in Public Health

Example Infectious Disease • Disease: Seasonal influenza • Primary prevention: – – target population – everyone; all ages Goal – reduce number of cases of flu Rationale – reduce exposures; bolster immune system Actions • Education: cough and sneeze etiquette, hand washing, know risk groups • Immunization: vaccination to develop antibodies • Interventions at the individual level: – vaccinate; good nutrition, sleep, and exercise to optimize health; good cough/sneeze etiquette; frequent hand washing; avoid others who are sick • Interventions at the community/population level: – Provide access to vaccines – Use Public Service Announcements (PSAs) to educate public – Prepare plans for schools, worksites, and hospitals/clinics for outbreak

Example: Infectious Disease • Disease: Seasonal influenza • Secondary prevention: – – target population – everyone who has been exposed to the virus Goal – reduce number and severity of cases of flu Rationale – early treatment to reduce severity of disease Actions • Screening: identify those who are most likely exposed from those who are not • Early treatment • Immunization: vaccination to develop antibodies • Interventions at the individual level: – Post flu symptoms and suggestions for self-care – Provide antiviral within 48 hours of symptom onset • Interventions at the community/population level: – Use quarantine or isolation measures; ban gatherings of large groups; travel restrictions – Send sick children home from school; enforce sick leave at work

Example: Infectious Disease • Disease: Seasonal influenza • Tertiary prevention: – target population – everyone who has influenza – Goal – reduce number and severity of flu-related complications and deaths – Rationale treatment and rehabilitation can reduce deaths and help return individual to a normal lifestyle – Actions • Provide supportive care and early treatment of complications • Use rehabilitation to increase recovery of normal lifestyle • Interventions at the individual level: – Tailor treatment to symptoms; monitor and treat complications • Interventions at the community/population level: – Ensure access to treatment (health insurance, local clinics available) – Protect employees who are out sick from losing jobs – Research to find better treatments; monitor resistance patterns

Role of Pharmacists in Prevention • Traditionally involved in – Tertiary prevention for individuals – Secondary prevent for individuals • Can expand into – Primary prevention for individuals or populations – Tertiary or secondary prevention for populations

Summary • Disease prevention aims to reduce avoidable morbidity and premature mortality by reducing exposure and disease severity, and facilitating recovery • Disease prevention efforts complement health promotion efforts • There are three levels of prevention. They vary in their target populations, rationales, goals, activities, and outcome measures • Pharmacists can be involved in prevention at both the individual patient and community or population levels.