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