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Preventive medicine

Last updated: November 11, 2021

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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 measles immunization, 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.
  • Measures [1][2]
    • Target: entire population
    • Health promotion beginning in childhood to encourage positive and discourage negative lifestyle habits
    • Mass education
    • Legislation
  • Examples
    • 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

Primordial prevention aims to prevent risk factors from developing in the first place, whereas primary prevention targets existing risk factors to prevent the onset of a disease.

  • Definition: actions targeted at preventing specific diseases from occurring to decrease the incidence and, subsequently, the prevalence of those diseases
  • Measures [2][3]
    • Target: entire population and select groups (healthy individuals)
    • Decrease incidence and, in turn, prevalence of a specific disease
    • Primarily done through
      • Health promotion (health interventions, lifestyle modifications)
      • Environmental modifications (e.g., work safety)
      • Specific protection interventions (immunizations, chemoprophylaxis, safety of drugs and food)
  • Examples
Overview of preventive counseling [4]
Condition Approach Population Age group
Smoking cessation
  • Inquire about tobacco use and recommend cessation if the patient is a smoker.
  • Discuss consequences of smoking.
  • Provide information on smoking cessation strategies:
  • General population
  • Pregnant individuals
  • All age groups
Cardiovascular risk factors
  • Promote a healthy diet (rich in vegetables, fruit, whole grain, fiber, and protein; low in saturated fats, red meat, alcohol)
  • Promote physical activity (≥ 150 minutes of moderate-intensity activity or 75 minutes of high-intensity aerobic activity per week)
  • All adults
Sexually transmitted diseases (STDs)
  • Provide behavioral counseling to prevent sexually transmitted infections (e.g., counseling, decrease the number of sex partners, promote safer sex practices)
  • All sexually active individuals, esp. such who engage in risky sexual behavior (e.g., lack of condom use, multiple sex partners)
  • Individuals with diagnosis of STD
  • General population with onset of puberty (approx. 12 years of age)
  • Inquire about special diets, e.g., vegan diet, vegetarian diet
  • Provide dietary counseling to ensure a well-planned diet and prevent nutritional deficiencies, including:
  • 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)
  • All age groups
Substance use
  • Inquire about substance use and misuse of prescription drugs.
  • Use screening questionnaires
  • Recommend psychiatric treatment to patients with positive screening results.
  • All pregnant women
  • General population with onset of puberty (approx. 12 years of age)
  • Definition: actions targeted at early detection of disease in asymptomatic patients (or while the symptoms of the condition are still mild) to promote early intervention
  • Measures [2]
    • Target: patient groups
    • Prevent further progression and complications from the disease
    • Consists of a two-step process: screening test to identify disease and follow-up for disease management

Screening complements diagnostics, but it is not a substitute.

Overview [4][5]
Condition Test Population Frequency
Risk Group Age group
  • General population
  • ≥ 18 years
  • Every 3–5 years
  • Individuals at high risk for hypertension (e.g., high-normal blood pressure, obese patients)
  • ≥ 40 years
  • Every 1–2 years
Hyperlipidemia [6]
  • All age groups
  • Every year
  • General population
  • Men: 20–45 years
  • Women: 20–55 years
  • Every 5 years
  • Men: 45–65 years
  • Women: 55–65 years
  • Every 1–2 years
  • > 65 years
  • Every year
  • 3 years
  • Repeat at 9–11 years of age
  • Repeat at 18 years of age
  • > 16 years
  • Every 5 years
  • Men: > 35 years
  • Women: > 45 years
  • Every 5 years
  • Once between 9–11 years and once between 17–21 years
  • Children
  • 9–11 years
  • 17–21 years
Abdominal aortic aneurysm
  • 65–75 years
  • Once
Overview [4][5]
Condition Test Population Frequency
Risk Group Age group
Diabetes mellitus
  • 35–70 years
  • Every 6 months
  • Individuals with blood pressure > 135/80 mmHg
  • > 45 years
  • Once
  • Women
  • > 65 years
  • Once
Overview [4][5]
Condition Test Population Frequency
Risk group Age group
Colorectal cancer
  • General population
  • 45–75 years
  • Every 10 years
  • All age groups, beginning 8 years after diagnosis
  • Every 1–2 years
  • 10 years
  • Every year
  • 20 years
  • Every 1–2 years
  • General population
  • 50 years
  • Every 5 years
  • General population
  • 50 years
  • Every year
Breast cancer
  • Women
  • 50–74 years
  • Every 2 years
Lung cancer
  • Smokers ≥ 20 pack year
  • Current smoker or ex-smoker for 15 years
  • 50–80 years
  • Every year up to 3 consecutive times
Cervical cancer
  • Women
  • 21–29 years
  • Every 3 years
  • Women
  • 30–65 years
  • Every 5 years
Overview [4][5][7]
Condition Test Population Frequency
Screening group Age group
  • 15–65 years
  • All age groups at first prenatal visit
Hepatitis B
  • All age groups
  • All age groups at first prenatal visit
  • Annually
  • Regular screening for high-risk patients
Hepatitis C
  • All adults
  • All adults, especially:
    • Individuals born between 1945–1965 [8]
    • High-risk individuals (e.g., IV drug users, individuals who received blood transfusions before 1992, individuals with sexual partners at high risk)
  • All adults < 80 years
  • All age groups at first prenatal visit
  • Once
  • Regular screening in high-risk individuals
  • Sexually active women
  • Pregnant women
  • < 24 years
  • All pregnant patients < 25 years and ≥ 25 years with high risk of infection
  • ≥ 24 years
  • Sexually active individuals of all age groups
  • All age groups at first prenatal visit
  • Sexually active individuals every 3 months
Asymptomatic bacteriuria
  • Pregnant women
  • All age groups at 12–16 weeks gestation of first prenatal visit
  • All age groups at first prenatal visit (if later than 16 weeks gestation)
  • Once
Overview [4][5]
Condition Test Population Frequency
Risk group Age group
Rh incompatibility
  • Pregnant women
  • All age groups at first prenatal visit

Major depressive disorder

  • 12–18 years
  • Once
  • General adult population (including pregnant and postpartum women)
  • All age groups
  • Children
  • 3–5 years
  • Once
Intimate partner violence
  • All women of reproductive age
  • No evidence on appropriate screening intervals; many sources still recommend routine annual screening. [9][10][11]
  • Definition: actions taken to avoid unnecessary medical interventions by identifying actions that might cause harm rather than benefit patients
  • Measures [2][12][13]
    • Target: patient groups
    • Prevent overmedicalization (e.g., overdiagnosis, overtreatment)
    • Avoid unnecessary diagnostic studies or treatments without proven efficacy (e.g., only offer ethically acceptable interventions, use treatments previously assessed by randomized controlled trial with low risk of bias)
    • Avoid disease mongering, i.e., widening the definition of certain medical illnesses, to expand markets for those who deliver and/or sell medical treatments.
  • Examples [14]
  • Definition: the degree to which an individual follows prescribed medication regimens and medical advice [15]
  • Common reasons for poor adherence [16][17]
    • Medication
      • Forgetfulness (mostly occurs in older patients or patients with cognitive disabilities)
      • Financial burden (e.g., cost of medications)
      • Polypharmacy (e.g., multiple comorbidities, complex treatment regimen)
      • Poor education by health care provider regarding medication use, side effects, and consequences of poor adherence
      • Among adolescents: fear of stigma due to peer attitudes toward the illness and/or its treatment [18]
    • Lifestyle modification: lack of motivation
    • Cultural and personal beliefs
      • Personal health care beliefs (e.g., homeopathy)
      • Personal health care misconceptions (e.g., vaccine hesitancy)
      • Distrust of health care system
  • Strategies to encourage adherence
    • Identify potential barriers (e.g., disease-related knowledge)
    • A patient-centered approach
    • Communication about treatment options
    • Provide patient education
      • Written instructions regarding medication
      • Discuss medication side effects
      • Confirm the patient's understanding of the treatment instructions using the teach-back method. [19]
    • Reminder system
      • Regular follow-up visits
      • Email reminder programs
      • Electronic alerts
      • Phone call reminders
    • Peer-facilitated behavioral interventions to convey knowledge about the illness and social acceptance for its treatment [20][21]
      • 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).
  • Definition [22][23]
    • 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.
  • Examples
    • 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.
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