Thi Qar college of Medicine Family Community medicine

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Thi. Qar college of Medicine Family & Community medicine dept. Family Medicine Lec 3

Thi. Qar college of Medicine Family & Community medicine dept. Family Medicine Lec 3 post graduate-FAMCO prepared by: Dr. Muslim N. Saeed th Tuesday, November 18 , 2014

Preventive Health Care

Preventive Health Care

WHAT IS PREVENTION? The goal of preventive medicine is to protect, promote, and maintain

WHAT IS PREVENTION? The goal of preventive medicine is to protect, promote, and maintain health and well-being and prevent disease, disability, and premature death.

WHEN SHOULD PREVENTION BE CONSIDERED? Criteria for prevention: 1. 1. the burden of suffering

WHEN SHOULD PREVENTION BE CONSIDERED? Criteria for prevention: 1. 1. the burden of suffering caused by the problem. is determined not only by the prevalence of the health problem in the population, but also by the Seriousness of the health problem can be thought of in terms of the “ 6 Ds”: death, disease, disability, discomfort, dissatisfaction, and destitution.

Another useful way to think about seriousness of the health problem is in terms

Another useful way to think about seriousness of the health problem is in terms of disability-adjusted life years (DALYs). DALYs for a health problem are calculated as the sum of the years of life lost from premature mortality from that problem and the years lost from disability for incident cases of that health problem.

2. there must be an effective and safe intervention that improves outcomes. In primary

2. there must be an effective and safe intervention that improves outcomes. In primary prevention, the intervention must work to delay or prevent the health problem. In secondary prevention, there must be an effective treatment that prevents disease from advancing, and it must be more effective when applied at the time asymptomatic disease is found than if applied at the time the patient would have presented with symptoms.

3. A third criteria is cost-effectiveness. It is often assumed that prevention always saves

3. A third criteria is cost-effectiveness. It is often assumed that prevention always saves the health care system money. The question that must be asked is whether the preventive intervention is worth the cost in terms of lives saved, disability prevented, or quality of life gained.

Prevention and the Family Physician Prevention is central to family medicine for several reasons:

Prevention and the Family Physician Prevention is central to family medicine for several reasons: 1 - A key mission of family medicine is preserving health and maximizing function of patients throughout their lives. 2 - The most common causes of morbidity and mortality are preventable chronic diseases. 3 - Because care for patients within a family and community context, it is critical to linking preventive services in the clinic with community resources. 4 - family medicine has a strong foundation of behavioral medicine.

Evidence-Based Prevention Definitions primary, secondary, and tertiary prevention. . Primary prevention is defined as

Evidence-Based Prevention Definitions primary, secondary, and tertiary prevention. . Primary prevention is defined as interventions that reduce the risk of disease occurrence in otherwise healthy individuals. -Counseling patients to avoid smoking. -prescribing fluoride to children to prevent cavities.

Secondary prevention includes screening to identify risk factors for disease or the early detection

Secondary prevention includes screening to identify risk factors for disease or the early detection of a disease among asymptomatic and atrisk individuals. -Evaluating and treating abnormal blood pressure in adults is an effective way to identify individuals at risk for heart disease and provides an opportunity to intervene before the disease occurs. -Screening for colon cancer using colonoscopy to detect precancerous polyps. #Individuals who receive primary or secondary prevention services have no obvious signs of illness; in clinical terms, they are asymptomatic.

Tertiary prevention services are provided to individuals who clearly have a disease, and the

Tertiary prevention services are provided to individuals who clearly have a disease, and the goal is to prevent them from developing further complications. diabetes care, including regular retinal examinations, foot care, and management of blood sugar levels. # some believes that tertiary prevention is outside the scope of traditional prevention and should be a part of disease management.

# High standard of evidence that proposed prevention strategies, including screening, counseling, chemoprevention, and

# High standard of evidence that proposed prevention strategies, including screening, counseling, chemoprevention, and immunizations, have been proven to prevent disease. # Evidence-based prevention recognizes that doing something to healthy asymptomatic patients requires a good evidence base that the benefits of the intervention outweigh its harms.

# Preventive services also involve costs of time and money to the patient and

# Preventive services also involve costs of time and money to the patient and the health care system. # evidence-based prevention involves evidence derived from populations, and what “works” for a population may or may not be appropriate for an individual patient.

Challenges in Evidence-Based Prevention Evidence-based prevention faces three levels of challenges: 1 - determining

Challenges in Evidence-Based Prevention Evidence-based prevention faces three levels of challenges: 1 - determining which preventive services are effective. 2 - delivering the message to prioritize the effective Services. 3 - applying the evidence in clinical practice. Conducting systematic reviews of literature to determine which preventive services are effective is time and resource intensive. Prevention literature is limited in some areas, especially harms of preventive services, and because of these limitations, many guidelines use expert opinion as a type of evidence supporting recommendations.

Conflicting guidelines create confusing messages. Clinicians may have difficulty determining the methodologies of each

Conflicting guidelines create confusing messages. Clinicians may have difficulty determining the methodologies of each specific guideline (e. g. , consensus opinion, evidence based, evidence informed) and deciding which guideline to use in their practices. Evidence-based guidelines with transparent methodology are reproducible and more reliable for implementation. Prioritizing effective preventive services leads to decreased overuse of ineffective services and increased use of effective services.

Systems challenges, including a lack of linkages to community resources, delivery system support, and

Systems challenges, including a lack of linkages to community resources, delivery system support, and clinical information support (e. g. , reminder systems, electronic health records), make it difficult to apply evidence-based prevention in practice. A systematic approach to offering preventive services enables a busy clinician to prioritize the most effective services. A systematic team approach ensures that immunizations are administered on time, screening tests are done appropriately, and counseling services are offered to those who need them.

WHAT IS SCREENING? Screening is testing for a health problem or risk factor when

WHAT IS SCREENING? Screening is testing for a health problem or risk factor when there are no recognized signs or symptoms that would indicate the presence of that problem or risk factor.

World Health Organization Criteria for a Screening Test 1. The condition being screened for

World Health Organization Criteria for a Screening Test 1. The condition being screened for should be an important health problem. 2. The natural history of the condition should be well understood. 3. There should be a detectable early stage. 4. Treatment at an early stage should be of more benefit than at a later stage. 5. A suitable test should be devised for the early stage. 6. The test should be acceptable. 7. Intervals for repeating the test should be determined. 8. Adequate health service provision should be made for the extra clinical workload resulting from screening. 9. The physical and psychological risks should be less than the benefits. 10. The costs should be balanced against the benefits.

Statistical Concepts in Prevention 1 - Expressing the Burden of Disease Prevalence and Incidence

Statistical Concepts in Prevention 1 - Expressing the Burden of Disease Prevalence and Incidence Tracking prevalence and incidence over time can help to determine health care strategies aimed at limiting the burden of a disease.

2 - Morbidity is the impact of the disease on health and functioning, and

2 - Morbidity is the impact of the disease on health and functioning, and mortality is the degree to which a condition results in death. Some diseases may have a high prevalence but cause low morbidity, and other diseases may be rare but life threatening conditions.

Expressing Screening Test Accuracy # When deciding whether an assessment is a “good screening

Expressing Screening Test Accuracy # When deciding whether an assessment is a “good screening test, ” the accuracy of the test and the prevalence of the disease in the population to be screened are important factors. The accuracy of a test is its ability to measure the actual value of the quantity being measured. Sensitivity and specificity are two measures used to express the accuracy of a screening or diagnostic test.

# Positive and negative predictive values take into account the accuracy of the screening

# Positive and negative predictive values take into account the accuracy of the screening test and the prevalence of the disease, to express the likelihood that a test result is a true result rather than a false-positive or false-negative result.

# The positive predictive value is higher and the negative predictive value lower when

# The positive predictive value is higher and the negative predictive value lower when a test is used in a population with a higher prevalence.

Risk Factors A risk factor is a condition that is associated with an increased

Risk Factors A risk factor is a condition that is associated with an increased likelihood of a disease. Some risk factors are causal; the risk factor causes the disease. For example, smoking is a risk factor for and a proven cause of lung cancer. Other risk factors are associations; people living at northern latitudes are more likely to have multiple sclerosis (i. e. , there is no known causal relationship; it is simply an association).

Some risk factors are modifiable (i. e. , can be changed), such as smoking,

Some risk factors are modifiable (i. e. , can be changed), such as smoking, level of physical activity, and cholesterol levels, and others are non-modifiable, such as age, gender, family history, and race. Some risk factors are behavioral risk factors, such as alcohol use, physical activity, and diet, and some type of change in behavior is required to modify these risk factors.

When considering prevention programs, it is often costeffective to target populations who have a

When considering prevention programs, it is often costeffective to target populations who have a higher risk of disease rather than to offer the service to the general population, in whom the risk factor or disease may be uncommon overall.