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Last updated: November 11, 2021
Preventive medicine is the branch of medicine that deals not only with preventing disease from occurring, but also with halting disease progression and averting complications after disease onset. Disease prevention occurs on five levels, with measures ranging from health policies that affect the general population to specific treatments for particular patient groups: primordial prevention (actions that address environmental, socioeconomic, behavioral risk factors; e.g., smoking cessation campaigns), primary prevention (actions that inhibit the occurrence of specific diseases; e.g., immunization), secondary prevention (actions that inhibit the progress of specific diseases at an early stage to prevent or limit complications; e.g., screening), tertiary prevention (actions that inhibit the progress of specific diseases at an advanced stage to prevent or limit complications; e.g., blood pressure management in patients with hypertension), and quartenary prevention (actions that prevent over-medicalization and offer ethically acceptable interventions; e.g., pursuing nonaddictive strategies to managing chronic pain rather than prescribing opioids). One of the greatest challenges to preventive medicine is the “prevention paradox,” which states that preventive measures that benefit large populations have little impact on most people (e.g., even without measlesimmunization, only a relatively small proportion of the population would contract the disease). This leads to the common misconception that preventive measures provide no benefit to the individual as part of a larger population. Another challenge is poor medical adherence, i.e., the extent to which an individual follows prescribed drug regimens and medical advice, especially in patients who do not feel ill and, therefore, perceive the burden of prevention rather than its long-term benefits. Strategies to encourage adherence include a patient-centered approach, frequent follow-ups, and education regarding long-term consequences of medical conditions, behaviors, and lifestyle.
Definition: actions that address environmental, socioeconomic, and behavioral risk factors that affect a population as a whole to prevent potential disease or injury.
Target: entire population
Health promotion beginning in childhood to encourage positive and discourage negative lifestyle habits
Programs on food safety and nutrition guidelines
Campaigns discouraging tobacco and drug use (e.g., smoke-free air laws in public buildings)
Building bicycle and sidewalks to promote physical activity
Recommend nutritional supplementation and consumption of fortified foods (e.g., calcium-fortified foods such as soy products, vitamin D-fortified foods such as plant-based milk alternatives, cereal, juices)
Confirm the patient's understanding of the treatment instructions using the teach-back method.
Regular follow-up visits
Email reminder programs
Phone call reminders
Peer-facilitated behavioral interventions to convey knowledge about the illness and social acceptance for its treatment
Encourage adolescents with chronic illnesses to familiarize their peers with their illness and its treatment (e.g., an adolescent with type 1 diabetes mellitus may carry out routine insulin injections in the presence of their peers).
Encourage patients with chronic illnesses to seek support from peers with the same chronic illness (e.g., through online communities).
A preventive measure that benefits a population as a whole will offer little benefit to each individual member of that population (population approach to prevention; primordial and primary prevention)
A preventive measure that benefits a group of individuals susceptible to a particular disease will offer little benefit to the population as a whole (high-risk approach to prevention; secondary and tertiary prevention).
The high-risk approach and the population approach to prevention are complementary, but preventive medicine should prioritize preventing the underlying causes of disease (primordial and primary prevention) over reducing the impact of disease after it occurs (secondary and tertiary prevention).
The prevention paradox may lead to the misconception that a measure that provides no immediate benefit to the individual, provides no benefit to the entire population and that a small risk involved in a measure (e.g., vaccination) outweighs the benefits of that measure.
Misconceptions derived from the prevention paradox may negatively affect epidemiological policy as well as adherence in the population.
While heavy drinking carries a greater risk than moderate drinking, moderate drinking has a greater negative impact on the general population because the number of moderate drinkers is greater than that of heavy drinkers.
Seatbelt laws have prevented many severe injuries, yet the overall risk of dying in an accident due to not wearing a seatbelt is still low.
ANONIMO, de la santé Om, Organization WH, Who WH. Adherence to Long-term Therapies.
World Health Organization
Best ways to deal with noncompliant patients.
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