11. Prevention

Question 1

3 levels of prevention?

Answer 1

Address social determinants, Remove causes, and Individual medical care

Question 2

Primary prevention - public health? v. Individual medical care?

Answer 2

Remove causes of disease (water, sewers), affects most people pretty easily. Individual care: Immunization

Question 3

Herd effect?

Answer 3

Quarantine a significant amount of population enough, you’ll get a herd effect (even though not everyone is immunized)

Question 4

Individual medical care: Secondary prevention?

Answer 4

Delay or avoid serious implications of disease - treatment INTERVENTION! (like statins, etc). Usually individual level

Question 5

FDA v. Drug Reps?

Answer 5

FDA approves drugs for narrow use. Drug company promotes it for any other use would be punished, including reps if they were recorded. Now you’re allowed to say what you want to say under free speech.

Question 6

Types of preventative services? (4)

Answer 6

Screening, counseling, immunization, preventive intervention

Question 7

Pt payments for clinical preventive services?

Answer 7

With the ACA, NO COPAY for a bunch of these. The US clinical prevention services taskforce figures out what preventive services we should be using, and those services means no copays. So now it’s important to insurance companies and payers what the US CPST is actually recommending.

Question 8

3 types of population prevention services?

Answer 8

Infectious disease control (like sanitation, immunization, mosquito nets), behavior modification (taxes, laws), and social/economic policies/changes

Question 9

What kind of population prevention services fall under social/economic policies/changes?

Answer 9

Education, jobs, housing!!! Improvements on these fronts will help

Question 10

Prevention paradox.

Answer 10

1) Invest now?payoff later?maybe?? maybe not! 2)Beneficiaries don?t know or care about the prevention policies protecting them 3) Lowering population risk level slightly yields greater reduction than focusing on smaller, high risk groups 4) Success may not be obvious 5) Early detection may not matter in many cases

Question 11

Example of Lowering population risk level slightly yields greater reduction than focusing on smaller, high risk groups?

Answer 11

20% of our population drinks and gets into accidents, all that other risky shit. But we only focus on the 5% who are actually alcoholics. We should reduce overall drinking to healthy levels.

Question 12

We’re doing a lot better with cardiac disease mortality between 1980 - 2000. Why?

Answer 12

Pretty even split between changes in behavior and improvements in medical intervention.

Question 13

IS prevention cheaper than medical intervention?

Answer 13

NOPE, not necessarily. QUALY adjustments for both usually cost between 10-50k, and guess what….they average out to about the same costs. Why? Cuz we tend to apply them broadly across the population, so we spend a lot of money looking for disease in preventive interventions.

Question 14

Issues with PSA testing?

Answer 14

Men who get a PSA test are more likely to get surgical prostate removal, with no significant difference in death rate than if you didn’t get it removed

Question 15

USPSTF (US Preventative Services Task Force)…who’s their primary audience? What does the scope include (3)?

Answer 15

PCPs, for DISEASE PREVENTION. Screenings, counseling, preventive meds

Question 16

Where are USPSTF services offered, and who do the recommendations apply to?

Answer 16

Primary care setting, apply to people with no signs or symptoms (disease not yet present)

Question 17

How does USPSTF generally make recommendations?

Answer 17

Rigorous review of existing peer-reviewed evidence. They DON’T conduct the research studies, just review and assess the research. They evaluates benefits and harms of each services based on factors such as age and sex

Question 18

How does USPSTF specifically make recommendations?

Answer 18

Letter grades are assigned to each recommendation statement. These grades are based on the strength of the evidence, usually on two criteria…service effectiveness, and how certain that net benefit is substantial (the latter includes cost). (A = recommend! D = not so much, and randomly…I = insufficient evidence)

Question 19

Who make up the USPSTF?

Answer 19

A bunch of appointed volunteer representatives

Question 20

What does USPSTF say about HIV? HepC?

Answer 20

HIV = A. Hep C = B for younger, C for older results.

Question 21

CPSTF (Community Preventative Services Task Force). Who staffs/funds?

Answer 21

Volunteer members, staffed/funded by CDC.

Question 22

CPSTF Overview?

Answer 22

Use Community Guide (aim at PH ACTORS, community groups working on health issues) to assess community interventions, including economic analysis.

Question 23

CPSTF on obesity?

Answer 23

Provider-oriented education interventions not expected to work as well as community interventions

Question 24

Finding/recommendation of Black Coral Task Force?

Answer 24

Use provider behavior, media, community strategies to reduce breast/cervical cancer incidence

Question 25

Lehnert Graphic?

Answer 25

There are 4 possible outcomes/quadrants. Intervention will fall into 1 of 4 quadrants (combo of increase-decrease costs and negative-positive health impacts). Each possible intervention is in 1 of the 4 quadrants. This begins to give you some criteria for what you want to try.

Question 26

Relative health care costs of different cohorts?

Answer 26

Health-livers were most expensive; smokers least expensive. Healthy people live longer and incur more costs overall. OBESE patients cost more over short period of time (expensive at beginning but don?t live long enough to get expensive diseases at the end). This does NOT include overall costs (like employment, disability, etc).

Question 27

Which world diseases affect potential income the most?

Answer 27

Diarrhea, lower respiratory infections, and injuries. Keep in mind that things like diarrhea affect children and its cause is ENVIRONMENTAL….

Question 28

What is the EPA responsible for?

Answer 28

Charged with reducing/preventing environmentally caused disease

Question 29

EPA tools? (3)

Answer 29

Set Standards for how much hazard is allowed, reduce pollutants with standards, Prior approval to build/open NEW industry

Question 30

How does FDA v. EPA enforce?

Answer 30

FDA can act more directly; EPA goes through the courts

Question 31

Heart of the EPA? (2)

Answer 31

Risk assessments and cost-effectiveness analysis