"What we as a society do to ensure the conditions in which people can be healthy."

-American Society of Health-System Pharmacists

Primary Prevention

*Taking action before a problem begins

-prevent the first occurrence of disease

*Objective:Prevent or change behaviors that cause problems or disease

-able to avoid problem entirely 

-no need to treat problem

-completely opposite from the medical perspective

*Taking action:

-After behavior begins

-After exposure to risk factor

-Before clinical symptoms and diagnosis of disease

*Objective: Early disease detection

-Decrease extent and severity of illness

-"Harm reduction"

-Individual has established disease or problem

-Objective:Minimize long-term consequences of disease

-May also be called "Treatment"

-Different from treatment-not trying to change the disease /problem itself, rather the effects of the disease

Examples

*Diabetes Self-Management Programs

*Rehabilitation programs

-substance abuse

-stroke

-injury

*Screening programs

-Breast and cervical cancer

-Mammography

-Diabetes screening

-Blood pressure checks

*Tobacco cessation programs

-May be listed as example of primary prevention

-Can be considered secondary because it is for those who have already begun the risk behavior

*Individual behavior change is difficult to make, difficult to keep up

*Best done on the policy level instead of the individual level

Examples

*Seat belts *Immunizations

*Alcohol laws *Parent education classes

*Harm reduction programs

-Acknowledge that behavior exists (no judgement about whether it should exist)

-No attempt to get people to stop risk behavior

-Efforts made to manage the risk, increase safety

*Examples:

-Needle exchange programs for IV drug users

-HIV testing for high-risk groups

-"Safer sex" education and condom distribution

-Designated driver campaigns

*Use the Socio-Egological Framework and the Spectrum of Prevention

*Using your focus topic or issue, identify one program or intervention in two of the target levels that a pharmacist could implement

*Identify what level of prevention

-Primary, secondary, tertiary

1. Program

-Place at appropriate level of Socio-Eco Framework

2. Level of Prevention Spectrum

-"Individual knowledge"

-"Educating providers"

3. Level of Prevention

-Primary, secondary, tertiary

*Emergency operations or Emergency prepardness is a set of doctrines to prepare civil society to cope with natural or man-made disasters.  Disaster relief is the subset of these doctrines that is concerned with recovery efforts.  This is usually a government policy adapted from civil defense to prepare for nonmilitary civil emergencies before they happen

*Natural

-weather related (hurricanes, tornados, etc)

*Earthquakes

*Fires

*Somewhat predictable

*Localized 

*Usually areas have plans and/or requirements to deal with or minimize damages

*Industrial explosians

*Hazardous material releases

*Building or bridge collapses

*Transportation crashes

*Unpredictable 

*Potential can sometimes be identified

*Terrorist attacks usually fall into this category

*Immediate injury and/or death to a large number of people

*Conditions that cause health risks to survivors

-contaminated air, water, and food

-exposure to radiation or toxins

-downed power lines or unstable buildings

-no access to needed medications

*Sharing information (two-way radios on same frequency)

*Resource management (personnel identifies and given assignments; supplies logged and allocated appropriately)

*Warnings (consistent and clear message delivered in as many ways possible)

*Search and rescue (coordinated; casulties communicated appropriately)

*Health risk (using mass media to warn of possible risks)

*Triage (method of sorting survivors by severity of injury)

*Casualty distribution (established protocols to ensure distribution of patients)

*Tracking (casualties and survivors; locations)

*Management of volunteers and donations (collected, organized and distributed at site outside disaster area)

*Establishing methods to care for patients in advance (access to medications)

Bioterrorism

Different kind of prepardness strategy

-Ability to identify an attack is underway

-Education of healthcare workers to identify unusual diseases

-Monitoring ER for patterns

-Labs with enhanced screening capabilities

-Improved communications

Bioterrorism

Category A agents

-Easily disseminated or transmitted person-to-person

-High mortality

-Require special actions

-Examples: smallpox, anthrax, plague, botulism, tularemia, filoviruses, arenaviruses

Bioterrorism

Strategic National Stockpile

-Medical supplies

-Antibiotics

-Vaccines

-Chemical antidotes

-Can be delivered anywhere in the US within 12 hours

Disease Outbreak

Swine Origin Influenza A Virus

-H1N1 subtype

-Reached pandemic status

-Lab tests available 

-Limited supply of medications at onset

-Ramifications for 2009 flu season

1. Insulin (8%)

2. Anticoagulants (6.2%)

3. Amoxicillin (4.3%)

4. Aspirin (2.5%)

5. Trimethoprim-sulfamethoxazole (2.2%)

6. Hydrocodone/acetaminophen (2.2%)

7. Ibuprofen (2.1%)

8. Acetominophen (1.8%)

9. Cephalexin (1.6%)

10. Penicillin (1.3%)

-Incorrect doses

-Taking doses at the wrong times

-Forgetting to take doses

-Stopping the medication too soon

1. Insulin (4% of all medication errors in 2005)

2. Morphine (2.3%)

3. Potassium chloride (2.2%)

4. Albuterol (1.8%)

5. Heparin (1.7%)

6. Vancomycin (1.6%)

7. Cefazolin (1.6%)

8. Acetominophen (1.6%)

9. Warfarin (1.4%)

10. Furosemide (1.4%)

5 Rights of Safe Medication Use

1. Right patient

2. Right drug

3. Right time

4. Right dose

5. Right route of administration