Once you have HTN and high cholesterol, in seeking to control them you are enacting tertiary prevention...right?
Controlling High BP and Cholesterol: Secondary vs. Tetiary Prevention?
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If it is asymptomatic then i believe it is secondary prevention. Tertiary prevention is like stroke rehab (disease has already happened and caused symptoms).
Secondary is all about early detection and treatment before it is symptomatic.
Anyone correct me if I am wrong...but this my understanding.
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I think primary prevention is any screening methods to try to prevent disease (e.g. Pap smears). Then secondary prevention is what you do after you get a disease diagnosis to prevent progression, for example the post-MI or post-stroke medications. So PRIMARY is about early detection and SECONDARY prevention is symptomatic but preventing ANOTHER (heart attack/stroke/etc).
Tertiary prevention I had not heard of before, but looked it up and it's what you said: stroke rehab programs or support groups to try to help quality of life and prevent further deterioration.
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HTN - Primary prevention is good diet, exercise regimen, low weight, etc. etc. to prevent (or delay) the diagnosis of HTN in a patient.
Secondary prevention is ONCE that patient has HTN (but no symptoms of it), your treatment (diuretics, ACEi, etc. etc.)
Tertiary prevention is after they have a stroke due to their uncontrolled HTN, then whatever rehab you do.
High cholesterol-
Primary = Before they have high cholesterol
Secondary = After they have disease (high cholesterol) but no acute illness
Tertiary = they've had an MI, and now you want to make sure they don't have another one.
http://en.wikipedia.org/wiki/Preventive_medicine
Primary prevention is defined as illness absent AND (underlying) disease absent.
Secondary is illness absent BUT (underlying) disease is present.
Tertiary is both are (or have been) present.
Secondary prevention is ONCE that patient has HTN (but no symptoms of it), your treatment (diuretics, ACEi, etc. etc.)
Tertiary prevention is after they have a stroke due to their uncontrolled HTN, then whatever rehab you do.
High cholesterol-
Primary = Before they have high cholesterol
Secondary = After they have disease (high cholesterol) but no acute illness
Tertiary = they've had an MI, and now you want to make sure they don't have another one.
http://en.wikipedia.org/wiki/Preventive_medicine
Primary prevention is defined as illness absent AND (underlying) disease absent.
Secondary is illness absent BUT (underlying) disease is present.
Tertiary is both are (or have been) present.
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Right it is easy to think of:
Primary as vaccines.
Secondary as pap smears.
Tertiary as stroke rehab.
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Why wouldn't Pap smears be considered primary prevention? A girl may not have any dysplasia or abnormality, no underlying disease, but going for routine screening.
Also, I thought after an MI, when you give medications (ACE, BB, statin) all that is considered secondary prevention... but it sounds like that is actually tertiary prevention?
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If the pap smear is positive it is too late for primary...you are testing for early signs of the disease (hence you are already on secondary prevention at this point).
Look at the colored table in http://en.wikipedia.org/wiki/Preventive_medicine
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Primary prevention in cervical caner is the HPV vaccine.
Secondary is Pap smears. Remember that Pap smears do not STOP cervical dysplasia from happening. They only allow us to determine that it is there. Secondary prevention also (probably) includes things like colpo, CONE/LEEP, anything that isn't "resection of cervical Ca".
And yes, after an MI, I would say that medications to prevent another MI are tertiary preventions. You need to have a systemic disease (like dyslipidemia/CAD) that presents as an acute illness (MI/stroke) in order to properly discuss prevention, IMO.
I think if they have symptoms or signs of HTN (e.g. hypertensive emergency/urgency or an S4 on auscultation), at that point it should be tertiary prevention/tx to prevent additional problems. But my confusion stems from how you define disease vs. illness for asymptomatic HTN. Elevated BP is GENERALLY not normal for the body. Would you say that an abnormality transitions from disease to illness only when you have signs or symptoms?
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I think it's a tougher clinical question. I would say that end-organ damage becomes an illness rather than a disease, and therefore S4, headaches, strokes, etc. would push it into tertiary prevention.
Asx HTN is a chronic disease, not an acute illness. That's how I think of it.
Yes, I believe so. All of this being said, this entire topic is more of a clinical barrier than it is UWorld/Step material. I can't remember seeing a single question on "what type of prevention is this".
Asx HTN is a chronic disease, not an acute illness. That's how I think of it.
Yes, I believe so. All of this being said, this entire topic is more of a clinical barrier than it is UWorld/Step material. I can't remember seeing a single question on "what type of prevention is this".
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Oh thanks that colored table makes sense.
I get it now... I just learned it the wrong way in the past!
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Yeah I can't imagine them testing "what type of prevention."
