The quaternary prevention, concept coined by the Belgian general practitioner Marc Jamoulle, are the actions taken to identify a patient at risk of overmedicalisation, to protect them from new medical invasion, and to suggest interventions which are ethically acceptable.
Quaternary prevention is the set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the health system.
Social credit that legitimizes medical intervention may be damaged if doctors do not prevent unnecessary medical activity and its consequences. Quaternary prevention should take precedence over any alternative preventive, diagnostic and therapeutic, as dictated by the principle of primum non nocere.
Video Quaternary prevention
Concept
Main idea: to avoid patient overdiagnosis and overtreatment.
Use: During all the episode of care (preclinical and clinical period).
It's the "actions taken to identify patients at risk of overtreatment, to protect them from new medical procedures and ethically acceptable alternative to suggest". The concept is included in WONCA's Dictionary of General and Family Medicine.
To do quaternary prevention is to say "no" to many considerably indecent proposals, and to offer prudent and scientific alternatives ("ethics of negation", "ethics of ignorance sharing"). To do quaternary prevention is to exchange the fear exploited by healthcare malice for the feeling of knowing that what matters is the quality of life.
The intent of quaternary prevention is not to eliminate but rather to moderate the medicalization of the daily life, since a part of the aforementioned medicalization is not directly related to the medical intervention and has to do with social, cultural and psychologic reasons. Quaternary prevention is only about avoiding or palliating the medical part of the medicalization of the daily life.
To do quaternary prevention in clinical encounters is to comply with the scientific goal of Medicine, which aims for "the maximum quality with the minimum quantity, as close to the patient as possible".
"To prevent is better than healing, when preventing is less harmful than healing". To engage into quaternary prevention is to avoid the unnecessary curative and preventive activities. Every doctor-patient encounter should include quaternary prevention in order to avoid/limit the damage caused by the activity of the health system. To do it is to enforce the old motto primum non nocere.
Maps Quaternary prevention
Means
1.- Narrative based Medicine
The strongest means to accomplish this is to listen better to our patients. This is what has been termed Narrative based Medicine, which means to adapt the medically possible to the individual needs and wants. What we need is a strong and sustainable relationship with our patients and their trust in our honesty and specific knowledge.
2.- Evidence-based medicine
The other important means is called Evidence based Medicine. The knowledge of the probable predictive values of diagnostic tests and the probabilities of effect sizes of benefit and harm of therapy and preventive measures give us the opportunity to leave out many useless procedures.
Intervention types
Healthcare professionals must be aware of the consequences of their decisions, and include quaternary prevention interventions in their daily clinical practice with each patient.
- To prevent the cascade effect:
- - To prevent the diagnostic cascade
- - To prevent the therapeutical cascade
- To prevent disease promotion
- To prevent medicalization
Activities
- Do not mistake risk factor with disease.
- To avoid check ups or unnecessary exams.,
- To avoid technical interventionism in healthcare.
- To avoid schooliosis.
- To avoid the pharmacological treatment of hypercholesterolemia in primary prevention.
- To avoid hormone replacement therapy during menopause
- To avoid the indiscriminate use of antibiotics (very often unnecessary, with the subsequent unjustified increase of bacterial resistances)
- To avoid unnecessary diagnosis of genetic disorders (for example: the promotion of the haemochromatosis screening, of doubtful scientific value, but of undoubted effect in terms of the medicalization of society.
- To avoid the overdiagnosis and overtreatment of the attention deficit hyperactivity disorder (ADHD).
- To elaborate validated diagnostic and therapeutic protocols that are effective in the prevention of the renal injury in the minority of patients with "complicated" pyelectasis, and that avoid the excessive amount of intervention in the majority of the patients with "simple" pyelectasis.
See also
- Bioethics
- Cascade effect
- Disease mongering
- Iatrogenesis
- Inverse benefit law
- Ivan Illich
- Medical ethics
- Medicalization
- Medicine
- Patient safety
- Preventive medicine
- Schooliosis
- World Organization of Family Doctors
References
Further reading
- Gofrit ON, Shemer J, Leibovici D, Modan B, Shapira SC. Quaternary prevention: a new look at an old challenge. Isr Med Assoc J. 2000;2(7):498-500.
- Ortún V. Gestión clínica y sanitaria. De la práctica diaria a la academia, ida y vuelta. Barcelona: Elsevier/Masson; 2003. p.245
- UEMO, European Union of General Practitioners / Family Physicians, Santiago LM. Quaternary prevention. Document 2008/040, October 2008.
- Gérvas J, Starfield B, Heath I. Is clinical prevention better than cure? Lancet. 2008;372:1997-99.
- Marc Jamoulle. Paradigm shift in Primary Care working fields. 11th congress of SBMFC, Brazilia, June 2011.
- Marc Jamoulle. la prévention quaternaire, une tâche explicite du médecin généraliste. Prospective Jeunesse. 2012; 7-11.
- Julien Nève, Marc Jamoulle. Quaternary prevention, an explicit task of the physician. Oct 25, 2012.
- Gérvas J. Prevención cuaternaria en ancianos. Rev Esp Geriatr Gerontol. 2012; 47(6):266-9.
- Quaternary Prevention (P4). Revista Brasileira de Medicina de Família e Comunidade. 2015; 10(35).
- PubMed: Quaternary Prevention
External links
- Equipo CESCA
- Marc Jamoulle
- REAP
- WONCA
Source of article : Wikipedia
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