Pharmacy in Public Health:

Levels of Disease Prevention

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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

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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

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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 long term disability

Levels of Prevention Table

Table 9.1 Pharmacy in Public Health

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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

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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.