• Clinical science

Preventive medicine

Abstract

Preventive medicine aims to reduce risks factors that contribute to disease development and progression. Such practices are divided into primary (e.g., immunization), secondary (e.g., screening tests), and tertiary prevention (e.g., medical or surgical therapy, rehabilitation). In addition, the term “primordial prevention” refers to measures that reduce health risks across a society (e.g., fortification of salt with iodine). The paradox of prevention is that the measures that benefit the population as a whole rarely benefit the individual.

See related learning card Epidemiology.

Prevention paradox

  • If a group is very large (e.g., the population of a country), there will always be a substantial number of cases of a particular disease or injury even if the risk is low.
  • Preventive measures that benefit a large group of people often provide little or no benefit for the individual.
  • Preventive measures that benefit a small group of people often provide little or no benefit for the population as a whole.

Primary prevention

Aims

  • Prevent the onset of specific diseases via risk reduction by altering behaviors or exposures that can lead to disease, or by enhancing resistance to the effects of exposure to a disease agent.
  • Primarily decrease the incidence, and in turn, decrease the prevalence of disease.

Examples

Secondary prevention

Aims

  • Early detection of disease in asymptomatic patients to promote early intervention, and to prevent further progression and complications from the disease.
  • Consists of a 2-step process: screening test to identify disease and a follow-up for management of the disease.

Examples

  • General medical examination (“checkup”)
  • Laboratory testing
  • Other screening tests

Secondary prevention testing measures are not intended to be diagnostic!

Tertiary prevention

Aims

  • Optimize care of patients with an established disease to improve functionality and prevent complications.
  • Lower the risk of relapse.

Examples

  • Blood pressure management
  • Diabetes management
  • Lifestyle modification

Adherence

  • Common reasons for patient nonadherence
    • Financial burden
    • Lack of motivation
    • Lack of understanding of the disease
    • Polypharmacy, multiple comorbidities, complex treatment regimen
    • Personal health beliefs
    • Lack of understanding the instructions provided by the physician
  • Strategies to encourage adherence:
    • Identify potential barriers
    • Open communication
    • Use a patient-centered approach
    • Provide patient education
      • Provide written instructions
      • Discuss medication side effects and consequences
    • Reminder system
      • Frequent follow-up visits
      • Call centers
      • Email reminder programs
      • Electronic alerts
      • Nurse coaches

References:[1][2][3]