Health Maintenance & Disease

3 Categories of Preventative Medicine

Primary- Remove or reduce disease risk factors ex. immunizations, preventing the use of tobacco

Secondary- early detection of disease (find and treat the pathology compared to later) ex. mammograms, pap smears

Tertiary- Limit impact of established disease ex. Mastectomy or someone who had breast cancer in the past

What are the top leading causes in al demographics of health in the USA in order?

1. Heart disease

2. Cancer

3. Unintentional injuries

4. Chronic lung diseases

5. Cerebrovascular disease

6. Alzheimer’s disease

What are the risk factors (allows disease to continue) for both sexes?

Tobacco

Hypertension

Overweight obesity

Physical inactivity

Hyperglycemia

High LDL cholesterol

Low dietary omega-3 fatty acids

High trans fats

Alcohol use

Deaths from all causes…

attribute to common preventable risk factors

Steps of functions of the History and Physical Exam

1. Information collection (about history or update)

2. Determination of patient values (ex. treatment perspectives for religious or end of life care)

3. Assessment & communication of prognosis

4. Establishment of a therapeutic relationship

5. Discussion of diagnostic testing and therapeutic options (demographics and history of sickness or likely)

6. Counseling, education and motivation for behavioral changes

Patient Compliance vs Adherence

Compliance: the extent to which the patient’s behavior coincides with

clinical advice (positive tone; patient/clinician as team)

Adherence: the extent to which a patient’s behavior corresponds with

agreed recommendations from a health care provider (negative tone; demanding)

Patient Compliance vs Adherence; Which one is more successful and one that we want to get better at?

Compliance- more successful

Adherence- want to get better at

Reasons for poor Adherence

Forgetfulness

Being away from home

Busy schedule

Changing daily routine

Psychiatric disorders

Uncertainly about treatment

effectiveness

Lack of knowledge about consequences

Treatment side effects

Cost of treatment

Ways to improve adherence

• Clinician-patient goals agreement (as a team with similar goals)

• Education (side effects or consequences of drug or risk factor)

• Provide more convenient care (offer telehealth, weekends)

• Simplify treatment regimens (once a day pill *vs 4 times a day pill)

• Reminders (Patient portal messages)

• Monitoring (Drug screening for drugs they should be taking and thoses that they shouldn’t be)

• Support system (Makign referrals)

What are screening tests used to do?

Screening tests are used to identify a disease/condition in a seemingly well

person for everyone in demographics

What criteria is used to determine if screening test is worthwhile

• Burden of disease sufficiency (Is the disease prevalent?)

• Test used must be high quality

• Evidence shows screening decreases morbidity & mortality (can you treat it and it prevents deaths?)

• Risk of harm

Give a Chart of screening a test vs not screening

Screening test performed- Treat early disease found by screen test- measure disease specific and total mortality rates

No screening performed- treat disease at time of clinical presentation- measure disease specific and total mortality rates