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{{Infobox diagnostic
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The '''quaternary prevention''', concept coined by the Belgian [[general practitioner]] [http://www.ulb.ac.be/esp/mfsp/prev4-fr.html Marc Jamoulle],<ref>[http://docpatient.net/mj/IIMG_1986.pdf Jamoulle M. Information et informatisation en médecine générale. In: Berleur J, Labet-Maris Cl, Poswick RF, Valenduc G, Van Bastelaer Ph. Les informa-g-iciens. Namur (Belgique): Presses Universitaires de Namur; 1986. p.193-209.]</ref> are the action taken to identify [[patient]] at risk of [[medicalisation|overmedicalisation]], to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.<ref>[http://docpatient.net/mj/P4_citations.htm Jamoulle M. About prevention; the Quaternary prevention. UCL. 2008]</ref>
| name = Quaternary prevention
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| purpose = identify patients at risk of overmedication
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The '''quaternary prevention''', concept coined by the Belgian [[general practitioner]] Marc Jamoulle,<ref>[http://docpatient.net/mj/IIMG_1986.pdf Jamoulle M. Information et informatisation en médecine générale. In: Berleur J, Labet-Maris Cl, Poswick RF, Valenduc G, Van Bastelaer Ph. Les informa-g-iciens. Namur (Belgique): Presses Universitaires de Namur; 1986. p.193-209.]{{dead link|date=July 2016 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>[http://docpatient.net/mj/P4_citations.htm Jamoulle M. About prevention; the Quaternary prevention. UCL. 2008]</ref><ref>[http://orbi.ulg.ac.be/bitstream/2268/177984/1/IJHPM29501422995400.pdf Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. International Journal of Health Policy and Management. 4-Feb-2015; 4:1–4.]</ref>


Quaternary prevention is the set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the [[health system]].<ref>[http://www.equipocesca.org/wp-content/uploads/2011/02/2004-06-la-prevencion-cuaternaria.pdf Gervás J. La prevención cuaternaria. OMC. 2004;(95):8.]</ref>
Quaternary prevention is the set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the [[health system]].<ref>[http://www.equipocesca.org/wp-content/uploads/2011/02/2004-06-la-prevencion-cuaternaria.pdf Gervás J. La prevención cuaternaria. OMC. 2004;(95):8.] {{webarchive |url=https://web.archive.org/web/20110726033754/http://www.equipocesca.org/wp-content/uploads/2011/02/2004-06-la-prevencion-cuaternaria.pdf |date=July 26, 2011 }}</ref>


== Explanation of term ==
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 is the practice version ''primum non nocere''.<ref name="Kuehlein">[http://www.primary-care.ch/docs/primarycare/archiv/de/2010/2010-18/2010-18-368_ELPS_engl.pdf Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoule M. Quaternary prevention: a task of the general practitioner. PrimaryCare. 2010; 10(18): 350-4.]</ref>
Marc Jamoulle divided medical situations into four quadrants based on if the patient was experiencing illness (i.e. if the patient experienced subjective poor health) and if the doctor had identified disease (constructed based on diagnostic criteria), with a different type of prevention happening in each:
# [[Preventive healthcare#Primary_prevention|Primary]] prevention when both illness and disease are absent
# [[Preventive healthcare#Secondary_prevention|Secondary]] prevention when illness is absent but disease is present
# [[Preventive healthcare#Tertiary_prevention|Tertiary]] prevention when both illness and disease are present
# Quaternary prevention when the patient is experiencing illness but there is no identified disease


Jamoulle noted that when the patient was experiencing illness but no specific disease had been identified that patient was particularly vulnerable to their condition being made worse by invasive or harmful diagnostic medical intervention.
== Concept ==
{| align="center" border="2" cellpadding="4" cellspacing="2" style="align:center; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;"
|rowspan=3 colspan=3 align="center" style="background:SandyBrown; color:white" |<big>'''Prevention levels'''</big> <ref name="Kuehlein" />
|colspan=2 align="center" style="background:green; color:white" |'''Doctor’s side'''
|-
|colspan=2 align="center" style="background:Crimson; color:white" |'''Disease'''
|-
! align="center" style="background:Yellow; color:Black"| absent !! align="center" style="background:red; color:white"| present
|-
! rowspan=2 align="center" style="background:green; color:white"|'''Patient’s<br />side'''
!! rowspan=2 align="center" style="background:Crimson; color:white" |'''Illness'''
!! align="right" style="background:Yellow; color:Black" | absent
| align="center" | '''[[Primary prevention]]'''<br />(illness absent<br />disease absent)
| align="center" | '''[[Secondary prevention]]'''<br />(illness absent<br />disease present)
|-
! align="right" style="background:red; color:white"|present
| align="center" | '''Quaternary prevention'''<br />(illness present<br />disease absent)
| align="center" | '''[[Tertiary prevention]]'''<br />(illness present<br />disease present)
⚫
|}


This original explanation is more limited than the more general term listed in the Wonca International Dictionary for General/Family Practice, "action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable".<ref name="Wonca dictionary">{{cite book |last1=Bentzen |first1=Niels |title=Wonca dictionary of general/family practice |date=2003 |publisher=Wonca International Classification Committee |location=[S.l.] |isbn=8788638227 |page=115 |url=http://www.ph3c.org/ph3c/docs/27/000092/0000052.pdf |access-date=30 May 2022}}</ref>
'''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 [[World Organization of Family Doctors|WONCA]]'s ''Dictionary of General and Family Medicine''.
<ref>[http://www.globalfamilydoctor.com/wicc/dictionary2.html Bentzen N, editor. WONCA Dictionary of general/family practice. Copenhagen: Maanedskift Lager; 2003.]</ref>

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.<ref>[http://www.gacetamedicabilbao.org/web/pdfdownload.php?doi=070037jg Gérvas J. Malicia sanitaria y prevención cuaternaria. Gac Med Bilbao. 2007; 104:93-6]</ref>

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.<ref>[http://www.actasanitaria.com/actasanitaria/frontend/desarrollo_noticia.jsp?idCanal=23&idContenido=23504 Gérvas J. Prevención cuaternaria. Acta Sanitaria. 2011/01/10.]</ref>

== 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.<ref>Greenhalgh T, Hurwitz B (ed.). Narrative based Medicine – Dialogue and Discourse in Clinical Practice. London: BMJ Books; 1998.</ref>

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.<ref>[http://www.equipocesca.org/wp-content/uploads/2009/04/el-trabajo-diario-c2a1basado-en-la-prevencion-cuaternaria.pdf Gérvas J. ¿El trabajo diario? ¡Basado en la prevención cuaternaria!. Boletín REAP. 2007; 4(1):6-7.]</ref>

* 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.,<ref>[http://www.equipocesca.org/wp-content/uploads/2009/01/uso-y-abuso-gaceta-2006.pdf Gérvas J. Pérez Fernández M. Uso y abuso del poder médico para definir enfermedad y factor de riesgo, en relación con la prevención cuaternaria. Gac Sanit. 2006; 20(Supl 3):66-71.]</ref><ref>Miguel F. Factores de riesgo: una nada inocente ambigüedad en el corazón de la medicina actual. Aten Primaria. 1998; 22:585-95.</ref>
* To avoid check ups or unnecessary exams.,<ref>[http://www.actasanitaria.com/actasanitaria/frontend/desarrollo_noticia.jsp?idCanal=23&idContenido=21082 Gérvas J. Chequeos. Acta Sanitaria. 2010/09/06.]</ref><ref>[http://www.fundacionmhm.org/www_humanitas_es_numero31/revista.html Segura Benedicto A. Cribado de enfermedades y factores de riesgo en personas sanas. El lado oscuro de la fuerza. Humanitas. 2008 sept; (31):1-17.]</ref>
* To avoid technical interventionism in healthcare.
* To avoid [[scoliosis]].
* To avoid the pharmacological treatment of [[hypercholesterolemia]] in [[primary prevention]].<ref>[http://www.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13086036&pident_usuario=0&pcontactid=&pident_revista=138&ty=90&accion=S&origen=elsevier&web=www.elsevier.es&lan=es&fichero=138v20nSupl.1a13086036pdf001.pdf Gérvas J. Moderación en la actividad médica preventiva y curativa. Cuatro ejemplos de necesidad de prevención cuaternaria en España. Gac Sanit. 2006; 20(Supl 1):127-34.]</ref>
* 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 (medicine)|screening]], of doubtful scientific value, but of undoubted effect in terms of the medicalization of society.<ref>[http://www.equipocesca.org/wp-content/uploads/2009/04/genetica-y-prevencion-cuaternaria-el-ejemplo-de-la-hemocromatosis.pdf Gérvas J, Pérez Fernández M. Genética y prevención cuaternaria. El ejemplo de la hemocromatosis. Aten Primaria. 2003; 32:158-62.]</ref>
* To avoid the [[overdiagnosis]] and [[overtreatment]] of the attention deficit hyperactivity disorder (ADHD).<ref>[http://www.pap.es/files/1116-930-pdf/1062.pdf Morell Sixto ME, Martínez González C, Quintana Gómez JL. Disease mongering, el lucrativo negocio de la promoción de enfermedades. Rev Pediatr Aten Primaria. 2009; 11(43):491-512.]</ref>
* To elaborate validated [[diagnostic]] and [[therapeutic]] [[Medical guideline|protocols]] that are effective in the prevention of the renal injury in the minority of patients with “complicated” [[pielic ectasia]], and that avoid the excessive amount of intervention in the majority of the patients with “simple” pielic ectasia.<ref>[http://www.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13076777&pident_usuario=0&pcontactid=&pident_revista=37&ty=65&accion=S&origen=elsevier&web=www.elsevier.es&lan=es&fichero=37v63n01a13076777pdf001.pdf González de Dios J, Ochoa Sangrador C. Ectasia piélica perinatal, efecto cascada y prevención cuaternaria. An Pediatr (Barc). 2005; 63(1):83-5.]</ref>


== See also ==
== See also ==
{{Portal|Medicine}}
{{Portal|Medicine}}
{{col div|colwidth=30em}}
* [[Bioethics]]
* [[Bioethics]]
* [[Cascade effect]]
* [[Cascade effect]]
* [[Disease mongering]]
* [[Defensive medicine]]
* [[Iatrogenesis]]
* [[Iatrogenesis]]
* [[Inverse benefit law]]
* [[Ivan Illich]]
* [[Medical ethics]]
* [[Medical ethics]]
* [[Medicalization]]
* [[Medicalization]]
Line 83: Line 37:
* [[Patient safety]]
* [[Patient safety]]
* [[Preventive medicine]]
* [[Preventive medicine]]
{{colend}}
* [[Schooliosis]]
* [[World Organization of Family Doctors]]


== References ==
== References ==
Line 90: Line 43:


== Further reading ==
== Further reading ==
* [http://www.ima.org.il/imaj/ar00jula-1a.pdf 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.]
* [https://web.archive.org/web/20110813065136/http://www.ima.org.il/imaj/ar00jula-1a.pdf 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.]
* [http://books.google.com/books?id=Yk5ORAzzYa0C&pg=PA223&dq=ortun&hl=es#v=onepage&q=&f=false Ortún V. Gestión clínica y sanitaria. De la práctica diaria a la academia, ida y vuelta. Barcelona: Elsevier/Masson; 2003. p.245]
* [https://books.google.com/books?id=Yk5ORAzzYa0C&dq=ortun&pg=PA223 Ortún V. Gestión clínica y sanitaria. De la práctica diaria a la academia, ida y vuelta. Barcelona: Elsevier/Masson; 2003. p.245]
* [http://www.uemo.org/members/official_documents/dwds08_2.htm UEMO, European Union of General Practitioners / Family Physicians, Santiago LM. Quaternary prevention. Document 2008/040, October 2008.]
* [http://www.uemo.org/members/official_documents/dwds08_2.htm UEMO, European Union of General Practitioners / Family Physicians, Santiago LM. Quaternary prevention. Document 2008/040, October 2008.]{{dead link|date=July 2016 |bot=InternetArchiveBot |fix-attempted=yes }}
* [http://www.equipocesca.org/wp-content/uploads/2009/03/prevention-lancet-final-2008.pdf Gérvas J, Starfield B, Heath I. Is clinical prevention better than cure? Lancet. 2008;372:1997-99.]
* [https://web.archive.org/web/20120317164646/http://www.equipocesca.org/wp-content/uploads/2009/03/prevention-lancet-final-2008.pdf Gérvas J, Starfield B, Heath I. Is clinical prevention better than cure? Lancet. 2008;372:1997-99.]
* [http://docpatient.net/mj/P4_brasilia_2011.pdf Marc Jamoulle. Paradigm shift in Primary Care working fields. 11th congress of SBMFC, Brazilia, June 2011.]
* [http://docpatient.net/mj/P4_brasilia_2011.pdf Marc Jamoulle. Paradigm shift in Primary Care working fields. 11th congress of SBMFC, Brazilia, June 2011.]
* [http://www.prospective-jeunesse.be/IMG/pdf/DSP60-JAMOULLE.pdf Marc Jamoulle. la prévention quaternaire, une tâche explicite du médecin généraliste. Prospective Jeunesse. 2012; 7–11.]
* [http://www.prospective-jeunesse.be/IMG/pdf/DSP60-JAMOULLE.pdf Marc Jamoulle. la prévention quaternaire, une tâche explicite du médecin généraliste. Prospective Jeunesse. 2012; 7–11.]{{dead link|date=July 2016 |bot=InternetArchiveBot |fix-attempted=yes }}
* [http://www.camfic.cat/Docs/12_13/P4interviewnevejamoulle2012.pdf Julien Nève, Marc Jamoulle. Quaternary prevention, an explicit task of the physician. Oct 25, 2012.]
* [https://web.archive.org/web/20130830105617/http://www.camfic.cat/Docs/12_13/P4interviewnevejamoulle2012.pdf Julien Nève, Marc Jamoulle. Quaternary prevention, an explicit task of the physician. Oct 25, 2012.]
* [http://equipocesca.org/new/wp-content/uploads/2012/12/QP-ancianos-Gervas-Rev-Esp-Geriatr-Gerontol-2012.pdf Gérvas J. Prevención cuaternaria en ancianos. Rev Esp Geriatr Gerontol. 2012; 47(6):266-9.]
* [http://equipocesca.org/new/wp-content/uploads/2012/12/QP-ancianos-Gervas-Rev-Esp-Geriatr-Gerontol-2012.pdf Gérvas J. Prevención cuaternaria en ancianos. Rev Esp Geriatr Gerontol. 2012; 47(6):266-9.]
* [http://www.ncbi.nlm.nih.gov/pubmed?term=%22Quaternary%20prevention%22 PubMed: Quaternary Prevention]
* [http://www.rbmfc.org.br/rbmfc/index Quaternary Prevention (P4). Revista Brasileira de Medicina de Família e Comunidade. 2015; 10(35).]
{{Unnecessary health care}}

== External links ==
*[http://www.equipocesca.org/ Equipo CESCA]
*[http://docpatient.net/mj/P4_citations.htm Marc Jamoulle]
*[http://www.reap.es REAP]
*[http://www.globalfamilydoctor.com/ WONCA]


[[Category:Evidence-based medicine]]
[[Category:Evidence-based medicine]]
[[Category:Healthcare quality]]
[[Category:Health care quality]]
[[Category:Medical ethics]]
[[Category:Medical ethics]]
[[Category:Medical terminology]]
[[Category:Medical terminology]]

Latest revision as of 00:03, 15 November 2024

Quaternary prevention
Purposeidentify patients at risk of overmedication

The quaternary prevention, concept coined by the Belgian general practitioner Marc Jamoulle,[1][2][3]

Quaternary prevention is the set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the health system.[4]

Explanation of term

[edit]

Marc Jamoulle divided medical situations into four quadrants based on if the patient was experiencing illness (i.e. if the patient experienced subjective poor health) and if the doctor had identified disease (constructed based on diagnostic criteria), with a different type of prevention happening in each:

  1. Primary prevention when both illness and disease are absent
  2. Secondary prevention when illness is absent but disease is present
  3. Tertiary prevention when both illness and disease are present
  4. Quaternary prevention when the patient is experiencing illness but there is no identified disease

Jamoulle noted that when the patient was experiencing illness but no specific disease had been identified that patient was particularly vulnerable to their condition being made worse by invasive or harmful diagnostic medical intervention.

This original explanation is more limited than the more general term listed in the Wonca International Dictionary for General/Family Practice, "action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable".[5]

See also

[edit]

References

[edit]
  1. ^ Jamoulle M. Information et informatisation en médecine générale. In: Berleur J, Labet-Maris Cl, Poswick RF, Valenduc G, Van Bastelaer Ph. Les informa-g-iciens. Namur (Belgique): Presses Universitaires de Namur; 1986. p.193-209.[permanent dead link‍]
  2. ^ Jamoulle M. About prevention; the Quaternary prevention. UCL. 2008
  3. ^ Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. International Journal of Health Policy and Management. 4-Feb-2015; 4:1–4.
  4. ^ Gervás J. La prevención cuaternaria. OMC. 2004;(95):8. Archived July 26, 2011, at the Wayback Machine
  5. ^ Bentzen, Niels (2003). Wonca dictionary of general/family practice (PDF). [S.l.]: Wonca International Classification Committee. p. 115. ISBN 8788638227. Retrieved 30 May 2022.

Further reading

[edit]
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