Class 12 Flashcards
Individual vs. Population
Patient vs. Community
Individual vs. Not a conscious decision by individual
Limited Scope vs. Broad Scope
Why is prevention less supported and funded than medical care?
Success is invisible, a lack of drama makes prevention less interesting, statistical lives saved have little emotional effect, there is usually a long delay before rewards appear, benefits do not accrue to the payer, persistent behavior change may be required, prevention is expected to produce a net financial return whereas treatment is expected only to treat the individual, commercial interests may conflict with disease prevention, advice might conflict with personal, religious, or cultural beliefs
Why did life expectancy in US increase steadily in the 20th century?
Vaccines, Antibiotics, Basic Sanitation
US has ________ life expectancy at birth among OECD comparable countries
lowest
Leading Causes of Death (2015-2016)
Heart Disease, Cancer, Unintentional injuries, Chronic Lower Respiratory Disease, Stroke
Leading Cause of Death Across All Ages
Heart Disease
Leading Cause of Death 1-14 years old
Unintentional Injury
Leading Cause of Death 15-44 years old
Unintentional injury
1st Epidemiology Revolution
Infections
Causes of 1st Epidemiology Revolution
Organisms
Risk Factors of 1st Epidemiology Revolution
Sanitation, hygiene, nutrition
Treatment of 1st Epidemiology Revolution
Antibiotics
Prevention of 1st Epidemiology Revolution
infrastructure, pasteurization, vaccines
Second epidemiology revolution
risk factors
causes of 2nd epi revolution
what people smoke, eat, and drink
prevention of 2nd epid revolution
screening, education, warning labels
What is Prevention?
interventions aimed at reducing incidence of disease and disability or slowing the progression and exacerbation of illnesses, much more broad than medical care system (includes individual, organizational, and societal actions)
Levels or preventions
primary, secondary, tertiary
primary level of prevention
prevent onset of disease before it even occurs
secondary level of prevention
screening/early detection; reduce impact of disease as it is discovered; try to reverse disease
tertiary level of prevention
maintain or improve function; manage long-term health problems and improve quality of life
examples of primary level prevention
immunizations, physical activity, healthy diet, better wages, stable housing, seatbelts, fluoridated water, de-leaded gasoline
implications of primary level prevention
May reduce population risk of disease, could save $$
examples of secondary level prevention
disease screening, smoking cessation, weight management programs
implications of secondary level prevention
Rarely cost saving, may be cost effective or good value
examples of tertiary level prevention
mode of transportation for trauma patients
implications of tertiary level prevention
increase quality of life and improve life expectancy
cost saving
cost of prevention is less than cost of treatment
cost effective
may not save money in medical treatment costs, but rather significant benefit to population or individual for the cost of prevention
health impact pyramid
bottom/population impact: socioeconomic factors, change the context to make individuals’ default decisions healthy, long-lasting protection interventions, clinical interventions, counseling and education top/individual impact
ACA mandated coverage for Preventive Services
private health plans must cover a range of a preventive services and may not impose cost-sharing on individuals for the services after passage of ACA
Four categories of ACA mandated coverage of preventive services
evidence-based screenings and counseling, routine immunizations, childhood preventive services, preventive services for women
no requirement that these services be cost saving
USPSTF
United States Preventative Services Task Force
USPSTF Grade A
The USPSTF recommends the service. There is high certainty that the net benefit is substantial.
USPSTF Grade B
The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
USPSTF Grade C
The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.
USPSTF Grade D
The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
USPSTF I Statement
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
Leading Cause of Death 45-64 years old
Cancer
Leading Cause of Death 65+ years old
Heart Disease
