1. Screening & Prevention
AK Nayyar

2. Prevention
Primary
Secondary
Tertiary

3. Screening
Defined as the application of sorting procedures to populations by doctor initiative with the aim of identifying asymptomatic disease or people at particular risk from it
It is a form of secondary prevention

4. Methods of screening
Opportunistic screening
True screening

5. Opportunistic screening
Adv.
Simple ,cheap to administer
Not dependent on patient compliance
Reaches people who will not attend for preventive advice only
• Disadv.
Does not offer 100% coverage
Time not protected
Patient may be less receptive when ill

6. Formal screening Adv. Protected time Purpose of attendance understood
As attendees are motivated so more receptive to advise
Comprehensive coverage of the topic
Financial incentive

7. Formal screening Disadv. Requires organisation ,time and commitment
Non attendance problem
Users are often those in least need of the service

8. Wilson criteria
Condition must be common, important, diagnosable by acceptable methods
There must be a latent interval in which effective interventional treatment is possible
Screening must be simple,cheap,cost-effective,continuous and on a group agreed by policy to be at high risk

9. Costs and benefits Benefits Improvement in mortality and morbidity
Economic saving on future treatment

10. Costs To patients Anxiety,false reassurance,economic costs
• To doctors
Time and resource cost
• To the NHS
Cost of test, cost of follow-up ,further investigation or treatment

11. Routine care
Preventive care
Patient initiated
Doctor initiated
Immediate type demand
Non-urgent
Usually involve doctor
Can delegate to Pm health care team member
Focused on individual
On high risk groups
Audit is difficult
Usually straight forward