Tingkat Pencegahan Penyakit (Level of Disease Prevention)

TINGKAT PENCEGAHAN
PENYAKIT
(LEVEL OF DISEASE
PREVENTION)
RETNO ASTI WERHANI

SETYAWATI BUDININGSIH
DEWI FRISKA
ARIA KEKALIH
 Mrs A, 65, who lives in east jakarta, went to her general
practitioner twice complaining she felt poorly. “The GP told me
there was nothing wrong. In his opinion, my condition was
perfectly fine for my age.”
 She had her first stroke shortly thereafter, and then a second
following a period of hospitalization.
WHAT DO YOU THINK OF THIS?

 Definition of Preventive Medicine
 Why Prevention
 History of Disease and Multiple Causal of Disease
 Level of Prevention
 Prevention in Primary Health Care
 Examples of Implementation
 Benefit of Prevention
 Promotion and Preventive Medicine
OUTLINE
 Preventive Medicine is a science and art to prevent
disease, prolonging life and promoting physical &
mental and efficiency
DEFINITION : LEAVELL & CLARK

1965
 Preventive Medicine focuses on the health of
individuals, communities, and defined populations.
 Its goal is to protect, promote, and maintain health and
well-being and to prevent disease, disability, and death
(American Collage of Preventive Medicine)
PREVENTIVE MEDICINE
PREVENTION ACTION IS TRIGGERED BY
DISEASE OCCURRANCE
WHO Statistics 2007

 The reduction of BP, reduces risk of acute cardiovascular
events, progression of atherosclerosis, and end organ
injury
 5 mmHg SBP reduction reduces 14 % stroke death and 9 %

CVD death (Chobanian et al, 2003)
 2 mmHg DBP reduction has benefit for prevention (Cook

NR, 1996)
HYPERTENSION
HEALTH ROAD MAP OF INDONESIA
RPJMN I RPJMN II RPJMN III RPJMN IV
2005 -2009 2010-2014 2015 -2019 2020 -2025
Bangkes diarahkan Akses masyarakat Akses masyarakat Kes masyarakat thp

untuk meningkatkan thp yankes yang terhadap yankes yankes yang
akses dan mutu berkualitas telah yang berkualitas telah berkualitas telah
yankes lebih berkembang mulai mantap menjangkau dan
dan meningkat merata di seluruh
wilayah Indonesia
KURATIF-
REHABILITATI VISI:
MASYARAKAT
F SEHAT
YANG MANDIRI
PROMOTIF - PREVENTIF DAN
BERKEADILAN
SHIFTNESS FROM CURATIVE & REHABILITATIVE HEALTH CARE TO PROMOTIVE –

PREVENTIVE 8
TRIAS EPIDEMIOLOGI
Nusantara Sehat 12/06/21

The Concept of Blum
Family Workplace
Environment
Genetics Health Status Behavior
Health Services
Nusantara Sehat
12/06/21
SOCIAL DETERMINANT OF HEALTH

The Mandala of Health culture
A model of human ecosystem
community
lifestyle
Personal family Psycho-socio-

Economic
behavior
spirit Environment
Sick
care body mind work
system
Human Physical
environment
biology
Human-Made Environment
biosphere
1. Health promotion
2. Specific Protection
3. Early Diagnosis & Prompt Treatment
4. Disability Limitation
5. Rehabilitation
 WHY PREVENTIVE : Is a broad perspective, including curative means that

“we should always thinking of prevention at every stage of the natural history of
disease”
FIVE LEVEL OF PREVENTION

 Clean and healthy life style
 Balanced nutritional intake
 Regular physical exercise
 No smoking
 No drinking
 No drug abuse
 Etc.
HEALTH PROMOTION
 Provision of clean drinking water
 Boiled drinking water
 Food quality monitoring
 Wash hand with soap
 Hepatitis B immunization
 Safe sex (use condom)
 etc
SPECIFIC PROTECTION
Specially for degenerative disorders
 Routine liver laboratory examination

 Routine BP, BG, and lipid examination
 Medical Check Up
EARLY DIAGNOSTICS
 Oral re-hydration fluid
 Intra venous fluid drips
 Antibiotics prescription
 Hepatic special diet
 Hepatic supplemental vitamins
 Etc.
DISABILITY LIMITATION
Specially for degenerative disorders
 Artificial anus
 Resection of colon cancer
 Endoscope Sclerotherapy
 Liver transplantation
 Etc.
REHABILITATION
 Action taken to identify patient at risk of overmedicalization, to protect him
from new medical invasion, and to suggest to him interventions, which are
ethically acceptable.’ (Wonca International Dictionary for General/Family
Practice)
 The concept of quaternary prevention was initially proposed by Marc Jamoulle
 the targets were mainly patients with illness but without a disease.
 New Definition : ‘action taken to protect individuals (persons/patients) from
medical interventions that are likely to cause more harm than good.’(Carlos
Martin et al. Quaternary prevention: reviewing the concept. Euro J Gen
Practice. 2018; 24(1): 106–111.
QUATERNARY PREVENTION
 Sustain warm and caring relationship with patient and family
 Sustain health efficacy
 Promote satisfying health provider and patient
 Promote self-control (both doctor and patient)
 Promote goal setting and decision-making
(Doll, Zucker, Brehm, 2004)
HEALTH PROBLEMS VS PREVENTION EFFORT
PREVENTION NEEDS AN EFFORT

 PROMOTION is a strategy to promote or Market an idea,
program. The goal of promotion is to make people to adopt the
idea/ program. Therefore it is related more to the method of
how to deliver it.
WHILE
 PREVENTION (HEALTH PROMOTION) is about WHAT
TO DELIVER (causal of disease, symptom, how to prevent,
therapy, impact, etc)
DEFINITION : PROMOTION AND

PREVENTION (HEALTH PROMOTION)
BENEFIT OF PREVENTIVE MEDICINE
 Providea wide perspective of activities toward a

patient/family/ community
 Isa COMPREHENSIVE APPROACH in providing care to
patient / family
 Support the quality of care to the patient
 Support
the Universal Coverage of Health services
(JKN/BPJS) system
 Providing
perspective for planning a program, evaluation a
program and Community diagnosis
CONCLUSION : PREVENTIVE MEDICINE
 Preventivemedicine is conducted by health personnel

(doctor, midwife, nurse, etc ) and other professional
 Preventivemedicine is everyone’s responsibility including
private and government sector
 Thereis a division of role among health professional in
implementing preventive medicine.
 Preventive medicine is a paradigm to efficiency.
COMM MED DEPARTMENT LECTURER
PUBLIC / POPULATIION
“An Ounce Of Prevention is Worth a
Pound of Cure”
BEN FRANKLIN
28
THANK YOU
DIFFERENTIATION
30

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TINGKAT PENCEGAHAN

RETNO ASTI WERHANI

WHAT DO YOU THINK OF THIS?

DEFINITION : LEAVELL & CLARK

WHO Statistics 2007

 5 mmHg SBP reduction reduces 14 % stroke death and 9 %

 2 mmHg DBP reduction has benefit for prevention (Cook

Bangkes diarahkan Akses masyarakat Akses masyarakat Kes masyarakat thp

SHIFTNESS FROM CURATIVE & REHABILITATIVE HEALTH CARE TO PROMOTIVE –

Nusantara Sehat 12/06/21

Genetics Health Status Behavior

Nusantara Sehat 12/06/21

Personal family Psycho-socio-

 WHY PREVENTIVE : Is a broad perspective, including curative means that

FIVE LEVEL OF PREVENTION

 Routine liver laboratory examination

HEALTH PROBLEMS VS PREVENTION EFFORT

PREVENTION NEEDS AN EFFORT

DEFINITION : PROMOTION AND

 Providea wide perspective of activities toward a

 Preventivemedicine is conducted by health personnel

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