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 carePreventive care Patient initiatedDoctor 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 difficultUsually straight forward