Prevention in General Practice
Definition
Prevention may be defined as the means of promoting and maintaining health or averting illness. It is concerned with:
- removal or reduction of risks
- early diagnosis
- early treatment
- limitation of complications, including those of iatrogenic origin
- maximum adaptation to disability.
Key Aspects of Prevention in General Practice
- Presenting complaint overt/covert
- Continuing care
- Coordination of care
- Modification of abnormal help-seeking behaviour
- Prevention, early detection, health promotion
Types of Prevention
Primary Prevention
Primary prevention includes action taken to avert the occurrence of disease. As a result, there is no disease. Primary preventive strategies include:
- Education to bring about changes in lifestyle factors known to be associated with diseases (e.g., smoking cessation, healthy balanced diets, exercise)
- Sterilisation of surgical instruments and other medical equipment
- Eradication, as with vector control of mosquitoes to prevent malaria
- Immunisation against infective diseases
- Sanitation, keeping our water supplies clean and disposing efficiently of sewage and industrial wastes
- Legislation to ensure that some of these primary preventive measures are carried out
Secondary Prevention
Secondary prevention includes actions taken to stop or delay the progression of disease.
The term is usually applied to measures for the detection of disease at its earliest stage, i.e., in the presymptomatic phase, so that treatment can be started before irreversible pathology is present.
Examples include:
- Early recognition of hypertension through routine testing (screening)
- Screening for cervical cancer to allow treatment of cervical dysplasia
- Mammography and endoscopy for polyps of the large bowel
Tertiary Prevention
Tertiary prevention includes the management of established disease so as to minimise disability.
- The term is usually applied to the rehabilitation process necessary to restore the patient to the best level of adaptation possible when there has been damage of an irreversible nature.
- A patient who has suffered a stroke because of hypertension may be restored to a useful lifestyle with appropriate rehabilitation.
Prevention is really wider than medical practice but because of the success of public health practices in the past, more attention is now being focused on prevention by doctors.
Optimal Opportunities for Prevention
The Royal College of General Practitioners (UK) has identified the seven most important opportunities for prevention as:
- Family planning
- Antenatal care
- Immunisation
- Fostering the bonds between mother and child
- Discouragement of smoking
- Detection and management of raised blood pressure (diabetes in Saudi Arabia)
- Helping the bereaved
Detection of common cancers that can be managed early with excellent prognosis
Barriers to Effective Preventive Services
- Difficult Access
- Financial Constraints
- Awareness and Education
- Cultural and Language
- Policy and Regulation
- Quick Wins Focus
- Personal
Prevention in General Practice