Bridging the gap between disease prevention and clinical management: a public health perspective

Abstract

Background: A significant gap exists between disease prevention and clinical disease management in health systems worldwide. Fragmented governance, financing, workforce structures, and information systems often delay preventive interventions and early diagnosis, resulting in avoidable acute care episodes and increased healthcare costs. Objective: To develop and evaluate the Prevention-Management Bridge Framework (PMBF), a structured public health model integrating disease prevention, early detection, and clinical management into population-based health system pathways. Methods: A systematic review of 25 peer-reviewed publications (2011–2024) was conducted using PubMed, Embase, Global Health, and WHO IRIS. This was followed by a retrospective analysis of health system performance data from 310 community-to-hospital pathway implementations across 14 countries. Framework synthesis, interrupted time-series analysis, and cost-effectiveness modelling were employed. Results: PMBF implementation increased disease prevention coverage by 60.6% and early-stage diagnosis by 70.4%, while reducing preventable hospitalizations by 44.0% and per-capita health system costs by 32.2%. Community health workers demonstrated the greatest scalability, while primary care–public health integration produced the most consistent improvement in care continuity (28–42%). Population health scores increased by 32.2%, and treatment adherence improved from 51.4% to 74.8%. Conclusion: Effective integration of prevention and clinical management requires structural redesign across governance, financing, workforce, information systems, and care pathways. The PMBF provides an evidence-based operational framework for health ministries, public health agencies, and health system managers seeking to improve population health beyond fragmented prevention or management approaches.