Lexique

Defining Tertiary Prevention

Defining Tertiary Prevention

Prevention is “all measures to avoid or reduce the number and severity of illness, accident and disability” (World Health Organization – WHO, 1948). It brings together all the actions, attitudes and behaviors that tend to avoid the occurrence of a disease or a health problem and to maintain or improve health. Tertiary prevention “comes at a stage where it is important to reduce the prevalence of chronic incapacity or recurrences and reduce complications, disabilities and subsequent relapse of disease” (WHO, 1984). It complements the primary and secondary prevention. It acts on the effects and consequences of a disease or its treatment. Its goal is to reduce the prevalence of chronic disability or recurrence in a population and reduce complications, disability or illness consecutive relapse. Tertiary prevention works hard on the medical, social and psychological rehabilitation for the chronically ill and help them participate in the life of society (Flageolet, 2008). Tertiary prevention is an important aspect of medical care and rehabilitation (Database on Public Health, 2013).

Definitions

An American commission on chronic illness proposed in 1957 one of the first definition of prevention in the field of health “all measures to avoid or reduce the number and severity of illness, accident and disability” (Commission on Chronic Illness, 1957). To consider all forms of action to prevent, the WHO to distinguish three categories since 1984 depending on when preventive action is proposed, (1) primary prevention that attempts to avoid occurrence of a disease or health problem, (2) secondary prevention, which aims to halt or delay the progression of a disease, or to reduce the risk of relapse and chronicity and (3) prevention service that occurs after the onset of the disease, which tends to reduce the damage caused by the disease, relapse, recurrence, disability (WHO, 1984). If other definitions and other classifications exist in the literature (Bourdillon, 2006; Trivalle, 2002), the classification of the WHO (1984) is the most universally accepted.

Public and specific modes of Action

Primary prevention is aimed at “healthy” unrecognized sick individuals, therefore, with disabilities or imprisoned. Secondary prevention targets people is declared sick, disabled or incarcerated or in the process of becoming. Tertiary prevention is for people diagnosed sick, disabled or incarcerated. The three areas of prevention require more specific and general educational intervention methods in primary prevention, therapy and more individualized in tertiary prevention.


What it means for Users

Whatever the stage of disease severity, intervention research shows that the shares of tertiary prevention allow patients to live better. Blog on Health aims to demonstrate these actions.

What it means for Health Professionals

Health professionals are encouraged to visit the website of the National Health Authority (HAS) where valuable information is given on shares of tertiary prevention (eg the 2011 report on non-drug therapies).

What it means for Researchers

Tertiary prevention involves a holistic, systemic approach (in the multifactorial causes and consequences) and temporal chronic disease (Bousquet et al., 2011).

What it means for policymakers

Tertiary prevention involves understanding chronic diseases globally (that is, understand the patient and not the disease or failing organ) and temporal.


Reference

Bourdillon F, Brucker G, Tabuteau D (2007). Traité de santé publique. Paris: Flammarion.

Commission on Chronic Illness (1957). Chronic illness in the United States. Cambridge: Harvard University Press.

Bousquet J, Abdelhak S, (…), Auffray C (2011). Systems medicine and integrated care to combat chronic noncommunicable diseases. Genome Medicine, 6, 43-46.

Flageolet A (2008). Rapport de mission au profit du gouvernement relative aux disparités territoriales des politiques de prévention sanitaire. Paris: Ministère de la Santé, de la Jeunesse et des Sport et de la Vie Associative.

Haute Autorité de Santé (2011). Développement de la prescription de thérapeutiques non médicamenteuses validées. Paris: HAS Edition.

Trivalle C (2002). Gérontologie préventive. Paris: Masson.

World Health Organization (1984). Glossary. Geneva: WHO Editions.


More References

Bodenheimer T (2008). Coordinating care – A perilous journey through the healthcare system. New England Journal of Medicine, 358, 1064-1071.

Bourbeau J, Collet JP, Schwartzman K, Ducruet T, Nault D, Bradley C (2006). Economic benefits of self-management education in COPD. Chest, 130, 1704-1711.

Bousquet J, Abdelhak S (…), Auffray C (2011). Systems medicine and integrated care to combat chronic noncommunicable diseases. Genome Medicine, 6, 43-46.

Boutron I, Ravaud P, Moher D (2012). Randomized clinical trials of non pharmacological treatments. Boca Raton : CRC Press Taylor & Francis.

Bryan S, Sofaer S, Siegelberg T, Gold M (2009). Has the time come for cost-effectiveness analysis in US health care? Health Economics, Policy and Law, 4, 425-443.

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal, 337, 979-983.

D’Ivernois J-F, Gagnayre R (2004). Apprendre à éduquer le patient : approche pédagogique. Paris : Maloine.

De Ridder D, Geenen R, Kuijer R, van Middendorp H. (2008). Psychological adjustment to chronic disease. Lancet, 19, 246-255.

Deccache A, Lavendhomme E (1989). Information et éducation du patient : des fondements aux méthodes. Bruxelles : De Boeck.

Dunbar-Jacob J, Mortimer-Stephens MK (2001). Treatment adherence in chronic disease. Journal of Clinical Epidemiology, 54, 57-60.

Effing T, Monninkhof EM, van der Valk PD, van der Palen J, van Herwaarden CL, Partidge MR, Walters EH, van der Palen J (2007). Self-management education for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 4, CD002990.

Griffiths TL, Phillips CJ, Davies S, Burr ML, Campbell IA (2001). Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax, 56, 779-84.

Jaquat D (2010). Education thérapeutique du patient : Propositions pour une mise en œuvre rapide et pérenne. Paris : Assemblée Nationale.

Lacroix A, Assal J-P (1998). L’éducation thérapeutique des patients. Nouvelles approches de la maladie chronique. Paris : Edition Vigot.

Neumann PJ, Palmer JA, Daniels N, Quigley K, Gold MR, Chao S (2008). A strategic plan for integrating cost-effectiveness analysis into the US healthcare system. American Journal of Management Care, 14, 185-188.

Ninot G (2013). Démontrer l’efficacité des interventions non médicamenteuses : Question de points de vue. Montpellier : Presses Universitaires de La Méditerranée.

Ninot G, Moullec G, Picot MC, Jaussent A, Desplan M, Brun JF, Mercier J, Hayot M, Prefaut C (2011). Cost-saving effect of supervised exercise associated to COPD self-management education program. Respiratory Medicine, 105, 377-385.

Nolte E, McKee M. (2008). Caring for people with chronic conditions: A health system perspective. Maidenhead : Open University Press.

Préfaut C, Ninot G (2009). La réhabilitation du malade respiratoire chronique. Paris : Masson.

Rea H, McAuley S, Stewart A, Lamont C, Roseman P, Didsbury P (2004). A chronic disease management program can reduce days in hospital for patients with COPD. Internal Medicine Journal, 34, 608-614.

Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB (2000). Evidence-Based Medicine: how to practice and teach EBM. London: Churchill Livingstone.

Sicard D (2002). La médecine sans le corps. Paris : Plon.

Traynard PY, Gagnayre R (2001). L’éducation du patient atteint de maladie chronique. L’exemple du diabète. ADSP, 36, 48-49.


Official Reports

Cour des Comptes (2011). Rapport sur la Prévention sanitaire de la Cour des Comptes à l’Assemblée Nationale. Paris: Assemblée Nationale.

European Chronic Disease Alliance (2010). A unified prevention approach: The case for urgent political action to reduce the social and economic burden of chronic disease through prevention. Brussels: Main European Medical Society.

European Commission (2013). Mental health Systems in the European Union Member States, Status of Mental Health in Populations and Benefits to be Expected from Investments into Mental Health European profile of prevention and promotion of mental health. Brussels: European Commission Editions.

European Union (2013). Economic analysis of workplace mental health promotion and mental disorder prevention programmes and of their potential contribution to EU health, social and economic policy objectives. Brussels: European Union Editions.

European Centre for Disease Prevention and Control (2011). Evidence-based methodologies for public health : How to assess the best available evidence when time is limited and there is lack of sound evidence. Stockholm: ECDC.

French National Academy of Medicine (2013). La Culture de prévention en santé : des questions fondamentales, report managed by Pr. Claude Dreux. Paris: Académie de Médecine.

Haut Conseil de la Santé Publique (2009). La prise en charge et la protection sociale des personnes atteintes de maladie chronique. Paris: HCSP.

Haut Conseil de la Santé Publique (2013). Évaluation du plan pour l’amélioration de la qualité de vie des personnes atteintes de maladies chroniques 2007-2011. Paris: HCSP.

Haute Autorité de Santé (2011). Développement de la prescription de thérapeutiques non médicamenteuses validées. Paris: HAS.

Institut National de Prévention et d’Education pour la Santé (2009). Agences Régionales de Santé : Promotion, prévention et programmes de santé, rapport dirigé par le Pr. François Bourdillon. Paris: Editions Sante Publique France.

Institut National de Prévention et d’Education pour la Santé (2010). Prospective santé 2030-prévention 2010. Paris: EditionsSante Publique France.

Institut National de Prévention et d’Education pour la Santé (2010). Education thérapeutique du patient. Paris: EditionsSante Publique France.

International Association of National Public Health Institutes (2011). National Public Health Institutes: European perspective. Brussels: Juvenes Print – Tampere University Print.

Ministère de la Santé (2006). Plan d’amélioration de la prise en charge de la douleur (2006-2010). Paris: Ministère de la Santé.

Ministère de la Santé (2007). Plan National Bien Vieillir (2007-2009). Paris: Ministère de la Santé.

Ministère de la Santé (2007). Plan pour l’amélioration de la qualité de vie des personnes atteintes de maladies chroniques et des Solidarités (2007-2011). Paris: Ministère de la Santé.

Ministère de la Santé (2008). Plan Santé des jeunes 2008-2010. Paris: Ministère de la Santé.

Ministère de la Santé (2008). Plan Alzheimer et maladies apparentées (2008-2012). Paris: Ministère de la Santé.

Ministre de la Santé (2008). Mission au profit du gouvernement relative aux disparités territoriales des politiques de prévention sanitaire. Paris: Ministère de la Santé.

Ministère de la Santé (2010). Plan National Maladies Rares (2011-2014). Paris: Ministère de la Santé.

Ministère de la Santé (2014). Les comptes nationaux de la santé en 2013, rapport dirigé par C. Zaidman, M.-A. Le Garrec et M. Bouvet. Paris: DREES.

Ministère de la Santé (2011). L’état de santé de la population en France. Suivi des objectifs annexés à la loi de santé publique, rapport dirigé par S. Danet. Paris: DREES.

Ministère de la Santé (2011). Programme National Nutrition Santé (2011-2015). Paris: Ministère de la Santé.

Ministère de la Santé (2013). Feuille de route de la Stratégie Nationale de Santé. Paris: Ministère de la Santé.

Ministère de la Santé (2014). Plan Cancer III 2014-2019. Paris: Ministère de la Santé.

Ministère des Sports (2013). Dispositifs d’activités physiques et sportives en direction des âgés, rapport dirigé par D. Rivière. Paris: Ministère de la Jeunesse et des Sports.

Ministère des Solidarités et de la Santé (2018). Plan Priorité Prévention: Rester en bonne santé toute sa vie. Paris: Ministère des Solidarités et de la Santé.

World Health Organization(1986). La charte d’Ottawa. Geneva: WHO Editions.

World Health Organization (2004). A strategy to prevent chronic disease in Europe: A focus on public health action. The CINDI vision. Geneva: WHO Editions.

World Health Organization (2006). Prévention des maladies chroniques: un investissement vital. Geneva: WHO Editions.

World Health Organization (2006). Gaining health: The European Strategy for the Prevention and Control of Noncommunicable Diseases. Copenhagen: WHO Editions.

World Health Organization (2008). Action plan for the global strategy for the prevention and control of non-communicable diseases (2008-2013). Prevent and control cardiovascular diseases, cancers, chronic respiratory diseases, diabetes. Geneva: WHO Editions.

World Health Organization (2013). Prevention and control of noncommunicable diseases in the European Region: a progress report. Copenhagen : WHO Editions.

World Health Organization (2014). Note d’orientation sur la prévention des maladies chronique. Geneva: WHO Editions.


To reference this Blog en Sante © article. 

Ninot G (2018). Définir la notion de prévention tertiaire. Blog en Sante, L15.

© Copyright 2018 Grégory Ninot. All rights reserved.