Pharmacy in Public Health: Levels of Disease Prevention Add course Date here

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 Whole population Exposed / risk factors Early Disease Late Disease

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

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.