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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
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
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 longterm disability
Levels of Prevention Table
Table 9.1 Pharmacy in Public Health
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
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.