.Prevention Helps Individuals Avoid Disease
Primary prevention is aimed at preventing the onset of disease. One way of doing
this is by controlling risk factors in healthy people that may lead to disease.
Examples of primary prevention include 1) immunizations to prevent communicable
diseases such as influenza or polio, and 2) the promotion of physical activity to
prevent conditions such as obesity that can lead to disease (e.g., type 2 diabetes).
Prevention Modifies Risk
Secondary prevention is aimed at treating a disease after its onset, but before it
causes serious complications. Secondary prevention includes 1) identifying
individuals with established disease, and 2) treating those individuals in a timely way
so as to prevent further problems (e.g., mammography screening to detect and treat
breast cancer in its earliest stages).
Prevention Reduces Disability
Tertiary prevention is aimed at treating the late or final stages of a disease so as to
minimize the degree of disability caused by that disease (e.g., administering a foot
check to a person with diabetes to identify infections that would require amputation
if left untreated).1-2
Primary prevention is aimed at preventing the onset of disease. One way of doing
this is by controlling risk factors in healthy people that may lead to disease.
Examples of primary prevention include 1) immunizations to prevent communicable
diseases such as influenza or polio, and 2) the promotion of physical activity to
prevent conditions such as obesity that can lead to disease (e.g., type 2 diabetes).
Prevention Modifies Risk
Secondary prevention is aimed at treating a disease after its onset, but before it
causes serious complications. Secondary prevention includes 1) identifying
individuals with established disease, and 2) treating those individuals in a timely way
so as to prevent further problems (e.g., mammography screening to detect and treat
breast cancer in its earliest stages).
Prevention Reduces Disability
Tertiary prevention is aimed at treating the late or final stages of a disease so as to
minimize the degree of disability caused by that disease (e.g., administering a foot
check to a person with diabetes to identify infections that would require amputation
if left untreated).1-2
There are several different approaches to providing preventive services:
Clinical preventive services, the focus of this guide, include those services that are typically
performed in a clinical setting and are conducted by a health professional such as a
physician, nurse practitioner, physician assistant, or health educator. Although most clinical
preventive services should be conducted during individual face-to-face office visits, some
services may be conducted in groups, via the telephone, or by email communication.
Community-based preventive services (also known as population-based preventive services)
include any kind of planned activity or group of activities (including programs, policies, and
laws) designed to prevent disease or injury or promote health in a group of people (e.g.,
fluoridation of drinking water, bans on tobacco use in public places).3
Worksite-based preventive services are health promotion programs provided to employees
and their dependents. The expressed purpose of these services is to improve employee health
and prevent disease by providing an opportunity for employees to engage in primary
prevention activities. Examples include:
• Employer-sponsored worksite fitness centers or healthy cafeteria programs that
encourage healthy lifestyles.
• Employer-sponsored health risk appraisals (HRAs) that identify employees at risk for
certain conditions and diseases (e.g., type 2 diabetes, heart disease, or hypertension)
and refer those employees to their health plan for continuing care.
• Employer-sponsored services such as employee assistance programs (EAPs) that can
help employees address health / lifestyle concerns, such as stress or substance use,
before the problems escalate into a clinical disorder (e.g., substance abuse, depression).
• Employer-initiated worksite smoking bans.
• Employer-sponsored worksite influenza immunization clinics.
Preventive Interventions
There are several types of preventive interventions: screening, testing, counseling,
immunization, preventive medication, and preventive treatment.
• Screening is best described as tests that assess the likelihood of the presence of a
disease or condition in an apparently healthy individual. Screening methods include
laboratory, X-ray, and similar technical methods; they also include questions asked by
a clinician. Screening may be targeted to people at increased risk due to age, gender,
family or personal history, or other factors. Each screening tool is different in design
and method, affecting the sensitivity (ability to correctly identify those with the
disease), specificity (ability to correctly identify those without the disease), and
positive and negative predictive values of the tool. Ideally, screening tests are rapid,
simple, and safe. It is important to note that, in most instances, screening is not a
definitive diagnostic test and that a positive result on a screening test merely indicates
that the screened individual has a higher likelihood of having the disease than a peer
with a negative result. Individuals who screen positive on such tests should have
confirmatory diagnostic tests to ensure an accurate diagnosis.4
• Testing refers to any process used to determine whether a condition is present (or not)
or to assess the status of a condition. Testing may involve questioning patients (e.g., a
mental status examination to determine whether thought processes are appropriate),
physical examination (e.g., examining a heart to detect a murmur or performing a
neurologic examination to detect nerve damage), or examining blood, body fluids, or
tissues (e.g., to detect anemia, to monitor levels of blood sugar, or to see if a cancer is
present in a biopsy sample). Testing may also require sophisticated technology, such as
CT or MRI scans and other X-rays, or invasive procedures, such as heart
catheterization to detect blockage of coronary arteries. Tests may be used to:
> Screen individuals who have risk factors, but no indication of having the
condition;
> Diagnose individuals who have symptoms and signs of a condition but where a
test will add certainty about the diagnosis; or
> Monitor the progress of an individual who is being treated or being considered
for treatment, such as monitoring blood pressure over time.
• Counseling refers to a discussion between a clinician and patient about ways that
changes in personal behavior can reduce risk of illness or injury. The goal of
counseling is for clinicians to educate patients about their health risks as well as to
provide them with the skills, motivation, and knowledge they need to address their
risk behaviors (e.g., 5A framework for tobacco cessation: Ask, Advise, Assess, Assist,
Arrange). A special kind of counseling, “informed decision making,” recognizes that
people make different decisions even though their situations may seem to be similar.
Informed decision making is structured to give an individual all the information
needed to choose among different clinical options, such as whether or not to undergo
genetic testing.
• Immunization protects an individual from a specific communicable disease (e.g.,
measles) by exposing the individual to an antigen or a trace amount of inactivated
disease-causing agent, spurring the development of natural immunity.
• Preventive Medications are used to prevent the onset of disease (e.g., aspirin therapy
to prevent cardiovascular events).
• Preventive Treatment involves a procedure intended to prevent the occurrence of a
disease or to prevent the progression of a disease from one stage to another. Preventive
treatments usually refer to the use of prescription or over-the-counter (OTC)
medications, but they may also involve prescriptions for lifestyle changes (e.g.,
exercise, diet change) or other interventions. Some surgical procedures may be
considered “preventive treatment,” such as when polyps in the colon identified during
a screening colonoscopy are removed in order to prevent their progression to cancer
lesions.
Clinical preventive services, the focus of this guide, include those services that are typically
performed in a clinical setting and are conducted by a health professional such as a
physician, nurse practitioner, physician assistant, or health educator. Although most clinical
preventive services should be conducted during individual face-to-face office visits, some
services may be conducted in groups, via the telephone, or by email communication.
Community-based preventive services (also known as population-based preventive services)
include any kind of planned activity or group of activities (including programs, policies, and
laws) designed to prevent disease or injury or promote health in a group of people (e.g.,
fluoridation of drinking water, bans on tobacco use in public places).3
Worksite-based preventive services are health promotion programs provided to employees
and their dependents. The expressed purpose of these services is to improve employee health
and prevent disease by providing an opportunity for employees to engage in primary
prevention activities. Examples include:
• Employer-sponsored worksite fitness centers or healthy cafeteria programs that
encourage healthy lifestyles.
• Employer-sponsored health risk appraisals (HRAs) that identify employees at risk for
certain conditions and diseases (e.g., type 2 diabetes, heart disease, or hypertension)
and refer those employees to their health plan for continuing care.
• Employer-sponsored services such as employee assistance programs (EAPs) that can
help employees address health / lifestyle concerns, such as stress or substance use,
before the problems escalate into a clinical disorder (e.g., substance abuse, depression).
• Employer-initiated worksite smoking bans.
• Employer-sponsored worksite influenza immunization clinics.
Preventive Interventions
There are several types of preventive interventions: screening, testing, counseling,
immunization, preventive medication, and preventive treatment.
• Screening is best described as tests that assess the likelihood of the presence of a
disease or condition in an apparently healthy individual. Screening methods include
laboratory, X-ray, and similar technical methods; they also include questions asked by
a clinician. Screening may be targeted to people at increased risk due to age, gender,
family or personal history, or other factors. Each screening tool is different in design
and method, affecting the sensitivity (ability to correctly identify those with the
disease), specificity (ability to correctly identify those without the disease), and
positive and negative predictive values of the tool. Ideally, screening tests are rapid,
simple, and safe. It is important to note that, in most instances, screening is not a
definitive diagnostic test and that a positive result on a screening test merely indicates
that the screened individual has a higher likelihood of having the disease than a peer
with a negative result. Individuals who screen positive on such tests should have
confirmatory diagnostic tests to ensure an accurate diagnosis.4
• Testing refers to any process used to determine whether a condition is present (or not)
or to assess the status of a condition. Testing may involve questioning patients (e.g., a
mental status examination to determine whether thought processes are appropriate),
physical examination (e.g., examining a heart to detect a murmur or performing a
neurologic examination to detect nerve damage), or examining blood, body fluids, or
tissues (e.g., to detect anemia, to monitor levels of blood sugar, or to see if a cancer is
present in a biopsy sample). Testing may also require sophisticated technology, such as
CT or MRI scans and other X-rays, or invasive procedures, such as heart
catheterization to detect blockage of coronary arteries. Tests may be used to:
> Screen individuals who have risk factors, but no indication of having the
condition;
> Diagnose individuals who have symptoms and signs of a condition but where a
test will add certainty about the diagnosis; or
> Monitor the progress of an individual who is being treated or being considered
for treatment, such as monitoring blood pressure over time.
• Counseling refers to a discussion between a clinician and patient about ways that
changes in personal behavior can reduce risk of illness or injury. The goal of
counseling is for clinicians to educate patients about their health risks as well as to
provide them with the skills, motivation, and knowledge they need to address their
risk behaviors (e.g., 5A framework for tobacco cessation: Ask, Advise, Assess, Assist,
Arrange). A special kind of counseling, “informed decision making,” recognizes that
people make different decisions even though their situations may seem to be similar.
Informed decision making is structured to give an individual all the information
needed to choose among different clinical options, such as whether or not to undergo
genetic testing.
• Immunization protects an individual from a specific communicable disease (e.g.,
measles) by exposing the individual to an antigen or a trace amount of inactivated
disease-causing agent, spurring the development of natural immunity.
• Preventive Medications are used to prevent the onset of disease (e.g., aspirin therapy
to prevent cardiovascular events).
• Preventive Treatment involves a procedure intended to prevent the occurrence of a
disease or to prevent the progression of a disease from one stage to another. Preventive
treatments usually refer to the use of prescription or over-the-counter (OTC)
medications, but they may also involve prescriptions for lifestyle changes (e.g.,
exercise, diet change) or other interventions. Some surgical procedures may be
considered “preventive treatment,” such as when polyps in the colon identified during
a screening colonoscopy are removed in order to prevent their progression to cancer
lesions.
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