Advances in health care come through both improvements in medical diagnosis, and treatment and efforts to prevent illness. Although emphasis is typically placed on diagnosis and treatment, the importance of prevention must not be overlooked. There are three levels of prevention: primary, secondary, and tertiary. Primary prevention aims to inhibit the development of disease or injury before it occurs; secondary prevention attempts to stop or reverse a problem before it becomes symptomatic through early detection; and tertiary prevention focuses on reducing disability and restoring functionality to people already affected by disease or injury.
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Tertiary prevention efforts are implemented in order to contain or retard damage that has resulted from a serious disease or injury, to prevent disability or recurrence of a condition, and/or to rehabilitate a patient (restore functionality and self-sufficiency). Often, the goal of tertiary prevention is to improve a suffering person's quality of life. Tertiary prevention can be applied to a variety of complicated, long-term health problems, including diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and chronic musculoskeletal pain.
Most current health care systems are based on testing, diagnosis, relieving symptoms and expecting a cure. According to the World Health Organization's fact sheet on "Integrating Prevention into Health Care," "While these functions are appropriate for acute and episodic health problems, a notable disparity occurs when applying this model of care to the prevention and management of chronic conditions." For chronic conditions, tertiary prevention may be much more helpful than testing, diagnosis or seeking a cure.
Tertiary prevention is conducted primarily by individuals and their health care practitioners (physicians, nurses and allied health professionals). In conducting tertiary prevention, health care professionals may make use of rehabilitation programs, chronic pain management programs and patient support groups. For people with severe arthritis, tertiary prevention often includes doing exercises, physiotherapy and taking medication to control inflammation and pain. For people with cancer, tertiary prevention often includes measures to keep the patient comfortable and the disease in remission for as long as possible. For people with disabling injuries, tertiary prevention includes intensive, long-term physiotherapy to regain use of limbs or develop alternate means for independent functioning.
Tertiary prevention can be very effective in reducing the severity and progression of disease and injury, limiting disabilities and improving suffering people's quality of life. According to "Prevention of Disease -- Tertiary Prevention," "Tertiary prevention efforts have demonstrated that it is possible to slow the natural course of some progressive diseases and prevent or delay many of the complications associated with chronic diseases."
A number of factors can influence the effectiveness of tertiary prevention efforts. For instance, some people may find healthful behaviours less appealing or convenient than unhealthful alternatives, while others may find it difficult to change habitual or addictive behaviours. People also must have sufficient knowledge and skills in order to know and understand what health behaviours to adopt, make plans for changing existing behaviour, and overcome obstacles to change. They also must have sufficient self-efficacy and confidence regarding their ability to carry out a lifestyle change. People's moods and energy levels, too, can impact a person's cognitive resources and motivation. A person's family and friends can model desired behaviours, and provide social support and encouragement for a person's attempts to alter his lifestyle; they can also hinder a person's tertiary prevention efforts by refusing to alter their own habits in order to help the other person. People are also more likely to follow through on personal lifestyle changes if they have been heavily endorsed by their health care providers.
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