Preventive Care
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Transcript of Preventive Care
Preventive Care
Department of Primary Care Medicine
University of Malaya
Case 1
• Sam, a 40 year old man, lorry driver
• History of hypertension x 5 years on atenolol
• Epilepsy x 20 years on phenytoin
• Smokes 10 cigarettes a day
• BMI 27kg/m
• Had an motor vehicle accident last night while driving
What are the issues?
What preventive care would you do?
Stott and Davis Model
A
Management of Acute Problem
B
Modification of health seeking behaviour
C
Management of Chronic Problem
D
Health Promotion/Disease
Prevention
10 years later
• He develops DM 1 year ago
• Develops right sided weakness x 2 days with slurring of speech
Preventive Care
• Primary Prevention
• Secondary Prevention
• Tertiary Prevention
Primary Prevention
• These are actions taken to avert the occurrence of disease
• Result – there is no disease!
Examples of primary prevention
• Immunisation
• Lifestyle changes
• Sterilisation of equipment
• Sanitation
Secondary prevention
• These are actions taken to stop or delay the progression of disease
• Used to detect diseases at its earliest stages
Examples of secondary prevention
• Hypertension – checking blood pressure in asymptomatic individuals
• Cervical cancer – doing Pap smears
Tertiary prevention
• These are management of established disease so as to minimize disability.
• Rehabilitation process
Examples of tertiary prevention
• Neurorehabilitation for stroke patients
• Cardiorehabilitation for IHD patients
Screening vs Case Finding
Screening
• Active pursuit of cases
Case finding
• Take the opportunity when the patient attends on another matter to screen him/her.
Wilson Criteria• Disease:
– Common/Important– Latent phase– Natural history
• Screening test– Simple, cheap. Accessible, affordable– Accuracy (Sensitivity and Specificity)– Continuous
• Follow-up– Facilities and manpower– Effective treatment– Policy of who to treat