Levels of Prevention in Healthcare Setting

A detailed overview of the levels of prevention including primary, secondary and tertiary prevention

1. SPECIFIC LEARNING Objectives At the end of this session, the participants should be able to Understand the history and classification of prevention. Classify the levels of prevention and the modes of intervention. Explain the same with the help of examples. Apply these levels in the management of patients.

2. University Questions Define intervention. Describe the different modes of intervention Primordial prevention Discuss the levels of prevention with reference to natural history of disease Define health promotion. Discuss in detail the role of health promotion in various national health programs

3. What is prevention? Definition: Activities designed to protect patients and other members of the public from actual or potential health threats and their consequences. - Mosby’s medical dictionary According to the WHO, disease prevention covers not only to prevent the occurrence of the disease , such as risk factor reduction , but also to arrest its progress and reduce its consequences once established.

4. Successful prevention depends upon: Knowledge of causation Dynamics of transmission Identification of risk factors/risk groups Availability of prophylactic or early detection and treatment measures Facilities for these treatment procedures Evaluation and development of these procedures

5. TIMELINE In 1958, Leavell and Clark in their book – “Preventive medicine for the doctor and his community” defined the 5 levels into 3 categories. Primary prevention Secondary prevention Tertiary prevention In 1978 Strasser introduced the concept of “Primordial prevention” Quaternary prevention - Marc Jamoulle ; Wonca International Classification Committee (WICC) in 2003

6. 1. Primordial Prevention Prevention of the emergence of the risk factors in population groups in which they have not yet appeared. Most commonly used for chronic diseases. Main intervention: Individual and mass education. Has to start in childhood when health risk behavior begins.

7. 1. Primordial Prevention Examples: Lifestyle modifications in children Promoting physical activities Teaching the ill effects of Smoking/drugs Ensuring a healthy diet

8. 2. Primary Prevention Action taken prior to the onset of disease, which removes the possibility that the disease will ever occur Accomplished by promoting the general health and well being, quality of life or by specific protective measures Main intervention : In the pre-pathogenesis stage

9. 2. Primary Prevention Examples: Lifestyle modifications & Physical activities in Adults Vaccines Chemoprophylaxis Environmental improvement: Rat control, Mosquito proofing

10. Primary Prevention Through primary prevention, we have been successful in controlling diseases like cholera, typhoid, dysentery, tuberculosis etc. Modes of intervention are: Health promotion Specific protection

11. Health promotion Interventions in this area are: a. Health education: Most cost effective. Target population include the general public, parents, priority groups, health providers, community leaders and decision makers. b. Environmental modification: Provision of safe water, installation of sanitary latrines, control of insects and rodents, improvement in housing conditions etc.

12. Health promotion c. Nutritional interventions: Food distribution and nutrition improvement of vulnerable groups, child feeding programs, food fortification, nutrition education etc. d. Lifestyle and behavioral changes

13. Specific protection Efforts directed to protect against specific diseases. Examples: Immunizations Use of specific nutrients Chemoprophylaxis Protection against occupational hazards Protection against carcinogens Protection against accidents Avoidance of allergens etc.

14. 2. Primary Prevention Approaches for primary prevention for chronic diseases Population/ mass strategy: Directed at the whole population irrespective of the individual risks Directed towards socio-economic, behavioral and lifestyle changes High risk strategy: To individuals at special risk

15. 3. Secondary Prevention Action which halts the progression of the disease at its incipient stage and prevents complications. Intervention is in the early pathogenesis stage It is the domain of clinical medicine DRAWBACK Patient is already subjected to mental anguish and physical pain. It is more expensive than primary prevention.

16. 3. Secondary Prevention MODES OF INTERVENTION Early diagnosis (screening tests, case finding programs) Adequate/ prompt treatment. EFFECTS Seeks out unrecognized cases Provides treatment before irreversible change occurs Reverses communicability of infectious diseases Protects the community

17. 4. Tertiary prevention All measures available to reduce or limit impairment and disabilities, reduce suffering caused by existing departures from good health and to promote the patients adjustment to irremediable conditions. Intervention is in the late pathogenesis stage Modes of intervention: Disability limitation Rehabilitation

18. Disability limitation To prevent or halt the transition of disease from impairment to handicap. Disease Impairment Disability Handicap

19. Accident Impairment: loss of anatomical structure Disability: lack of ability to perform an activity Handicap: prevents fulfillment of the normal role

20. Rehabilitation The combined and coordinated use of medical, educational, social and vocational measures for training and retraining the individual to the highest possible level of functional ability. Types: Medical : Restoration of function. Vocational : Restoration of the capacity to earn a living Social : Restoration of family and social relationships Psychological : Restoration of personal dignity and confidence

21. Rehabilitation Examples: Establishing schools for the blind. Provision of aids for the crippled. Exercises in neurological disorders. Prosthetic restoration of lost tooth Requires cooperation from different sections of the society.

22. Quaternary Prevention The action taken to identify the patient at risk of over medicalization, to protect him from new medical invasion and to suggest to him interventions which are ethically acceptable. Is the set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the health system.

23. Quaternary Prevention Healthcare professionals should be aware of the consequences of their decisions, and include quaternary prevention interventions in their daily clinical practice with patients. Do not mistake risk factor with disease. To avoid checkups and unnecessary tests. To avoid indiscriminate use of antibiotics etc.

24. QUIZ

25. All of the following represent Specific protection mode of prevention except: (a) Chemoprophylaxis for meningococcal meningitis (b) Personal hygiene and Environmental sanitation (c) Usage of condoms (d) Iodisation of salt Personal hygiene and Environmental sanitation is Health Promotion mode of intervention

26. Which of the following is an example of Disability limitation in poliomyelitis? (a) Reducing occurrence of polio by immunization (b) Arranging for schooling of child suffering fromPRPP (c) Resting affected limbs in neutral position (d) Providing calipers for walking Ans: Resting limbs in neutral position helps prevent overstretching of paralysed muscles, thereby limits further disability ‘Disability Limitation’ Reducing occurrence of polio by immunization: Primary Level of Prevention (Specific Protection) Arranging for schooling of child suffering from PRPP: Tertiary Level of Prevention (Vocational rehabilitation) Providing calipers for walking: Tertiary Level of Prevention (Medical Rehabilitation)

27. Secondary level of prevention include all of the following except: (a) Health screening for Diabetes Mellitus (b) Case finding for Falciparum Malaria (c) Contact tracing for STIs (d) Reconstructive Surgery in Leprosy Ans. (d) Reconstructive Surgery in Leprosy

28. Which of the following is the most logical sequence? (a) Impairment-Disease-Disability-Handicap (b) Disease-Impairment-Disability-Handicap (c) Disease-Impairment- Handicap-Disability (d) Disease-Handicap-Impairment-Disability Ans. (b) Disease-Impairment-Disability-Handicap