Chapter 9: Prevention in general practice

INTRODUCTION

DEFINITIONS¹

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; and maximum adaptation to disability.

The promotion of health concerns helping well people to learn healthy behaviours and to accept responsibility for their own well-being.

A preventive attitude implies that the doctor understands and can utilise the preventive potential in each primary care consultation by an ‘opportunistic approach’. In addition to the traditional management of both presenting and continuing problems, the doctor takes the opportunity to modify the patient's health-seeking behaviour, to provide education about the illness, and to promote health by relating the patient's present condition to previous unhealthy behaviour.

A general reference for prevention is the RACGP red book—Guidelines for preventive activities in general practice (9th edition). www.racgp.org.au/your-practice/guidelines/redbook.

Primary prevention

Primary prevention includes action taken to avert the occurrence of disease. As a result there is no disease. Primary preventive strategies include:

1. education to bring about changes in lifestyle factors known to be associated with diseases (e.g. smoking cessation, healthy balanced diets, reduction in alcohol intake, exercise)

2. sterilisation of surgical instruments and other medical equipment

3. eradication, as with vector control of mosquitoes to prevent malaria

4. immunisation against infective diseases

5. sanitation, keeping our water supplies clean and disposing efficiently of sewage and industrial wastes

6. 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. The early recognition of hypertension through routine testing (screening) of patients allows treatment during the presymptomatic phase of the illness process. Screening for cervical cancer allows the treatment of cervical dysplasia, a premalignant condition. Other examples include 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.

Relationship between types of prevention