Approaches to Preventive Care
Population And Targeted Approaches The two leading approaches to preventive care—the population strategy and the targeted (high-risk) strategy—were described in a seminal article by the British epidemiologist Geoffrey Rose.20 The population strategy seeks to shift the distribution of risk within an entire population toward a lower range—for example, by decreasing the amount of salt in the typical diet to reduce the population’s average blood pressure. The targeted strategy aims to truncate the risk distribution by identifying high-risk individuals and offering them interventions to reduce their individual susceptibility—for example, by screening blood pressure among the population and offering medication to people with hypertension.
An important advantage of the population strategy is its potential to make widespread improvements in public health.20 However, the benefit to each individual is relatively small using this approach. Most people experience no particular improvement in their health—a result known as the “prevention paradox.”20,21 In contrast, the targeted strategy provides customized care that maximizes outcomes for individual patients. But such customized care will rarely be cost-effective for all patients, and hence it should not be offered universally.
Approaches to Preventive Care
Population And Targeted Approaches The two leading approaches to preventive care—the population strategy and the targeted (high-risk) strategy—were described in a seminal article by the British epidemiologist Geoffrey Rose.20 The population strategy seeks to shift the distribution of risk within an entire population toward a lower range—for example, by decreasing the amount of salt in the typical diet to reduce the population’s average blood pressure. The targeted strategy aims to truncate the risk distribution by identifying high-risk individuals and offering them interventions to reduce their individual susceptibility—for example, by screening blood pressure among the population and offering medication to people with hypertension.
An important advantage of the population strategy is its potential to make widespread improvements in public health.20 However, the benefit to each individual is relatively small using this approach. Most people experience no particular improvement in their health—a result known as the “prevention paradox.”20,21 In contrast, the targeted strategy provides customized care that maximizes outcomes for individual patients. But such customized care will rarely be cost-effective for all patients, and hence it should not be offered universally.
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