PCM1: Health Promotion and Preventative Medicine

=Health Promotion and Preventative Medicine=

Types of prevention

 * 1) Primary prevention: reduction of risk factors for diseases before they occur (patient is asymptomatic)
 * 2) Secondary prevention: identifications and treatment of diseases or conditions at an early stage (patient is asymptomatic)
 * 3) Tertiary prevention: reduces future negative health effects of diseases or conditions in patients that have already become symptomatic

Describe the concept of health promotion
The process of enabling people to increase control over, and to improve, their health. This may involve promoting lifestyle changes, etc.Health promotion has basic prerequisites of peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. Once these are in place, the coordination of all areas (healthcare, government, economic sectors, inviduals, families…) are involved in promotion of health. (WHO)

Describe the role of the physician in health promotion activities
As a trusted source for health-related information, physicians are responsible for giving health recommendations and interventions, including counseling, screening tests/exams, immunizations, and chemoprophylaxis. They provide education, encouragement, reinforcement, and can guide patients through the steps of behavioral changes. As the source of screening/immunization/etc, they also contribute the clinical aspect of health promotion.

Once a physician has decided to implement a preventative practice, it is important that they 1) institute an office system to carry out the protocol, developing a tracking system, reminders for clinician & patient, etc and 2) involve the office/nursing staff.

Explain how behavior change functions in health promotion efforts
Behavior change is integral to the concept of health promotion – encouraging health means encouraging healthy behaviors, and the changes necessary to achieve these.

==Demonstrate screening strategies recommended for selected pts, using history, PE, and lab/diagnostic procedures

(detailed charts for screening recommendations based on risk factors at or by the AAFP (for download to a PDA):

Describe counseling to selected pts

 * Diet & Exercise (talk through recommendations of exercise, diet variety, portions, etc and how to work into pt’s lifestyle)
 * Substance Abuse (counseling: find out history, reason behind abuse, explore possible treatments/rehab methods (e.g. smoking cessation/alcoholism counseling), find support systems for process, positive reinforcement & f/u; can also offer immunizations (Pneumococcal for smoking, Hep B for pert. Drugs, TB test, Oral exams, injury prevention counseling, HIV test, as appropriate))
 * Sexual Practices (take sexual hx, possible HIV testing and counseling, STD testing and counseling, contraception counseling, Hep B immunization, HPV immunization for girls)
 * Injury Prevention (identify behaviors, talk through basic safety recommendations, i.e. wear a helmet…)
 * Other measures, immunizations & chemoprophylaxis (as appropriate, mammograms for women over 40/50, PSA testing, colonoscopy, blood pressure lowering meds for asymptomatic people

Follow steps, and identify where a patient is among the 6 stages:

 * Principles of Counseling:
 * 1) Develop therapeutic alliance
 * 2) Counsel all patients
 * 3) Ensure that patients understand the relationship b/w behavior and health
 * 4) Work w/ patients to assess barriers to behavior change
 * 5) Gain commitment from patients to change
 * 6) Involve patients in selecting risk factors to change
 * 7) Use a combination of strategies
 * 8) Design a behavior modification plan
 * 9) Monitor progress through f/u contact
 * 10) Involve office staff


 * 6 stages of change – meet the patient where they are on the wheel of change
 * 1) precontemplation
 * 2) contemplation
 * 3) preparation
 * 4) action
 * 5) maintenance
 * 6) termination