Quaternary prevention

Quaternary prevention describes the avoidance of unnecessary medical measures or over-medicalization.

The principle primum non nocere is a cornerstone of medicine . The task of avoiding too many medical interventions is of central importance, especially for family medicine .

concept

			unavailable	available
Types of prevention			Side of the doctor
			illness
Side of the patient	Health disorder	not available	Primary prevention (health disorder doesnot exist,illness does not exist)	Secondary prevention (health disordernot presentdisease present)
Side of the patient	Health disorder	available	Quaternary prevention (health disorder present disease absent)	Tertiary prevention (health disorder present disease present)

Quaternary prevention means preventing over- medicalization and useless medicine. Its aim is to identify patients who are at risk of being exposed to too many medical measures that may do them more harm than good, and to offer them acceptable alternatives. The concept of quaternary prevention was first described by Marc Jamoulle in 1986. In 1999 it was recognized by the Wonca International Classification Committee and published in the Wonca Dictionary of General / Family Practice in 2003.

medium

Narrative Based Medicine is the best means of implementation and means adapting what is medically possible to what is individually needed and desired. It requires a strong and stable relationship with the patient and their trust in medical sincerity and knowledge.
Evidence-based medicine is a further means: Knowledge of realistic predictive values of diagnostic tests and the expected effect sizes of the benefits and harms of therapy and early detection measures. This is what makes it possible to forego unnecessary medical interventions.

literature

ON Gofrit, J. Shemer, D. Leibovici, B. Modan, SC Shapira: Quaternary prevention: a new look at an old challenge. In: Isr Med Assoc J. 2 (7), 2000, pp. 498-500.
V. Ortún: Gestión clínica y sanitaria. De la práctica diaria a la academia, ida y vuelta. Elsevier / Masson, Barcelona 2003, p. 245.
J. Gérvas, B. Starfield, I. Heath: Is clinical prevention better than cure? ( Memento of October 14, 2009 in the Internet Archive ) In: Lancet. 372, 2008, pp. 1997-1999.
Marc Jamoulle: Paradigm shift in Primary Care working fields. 11th congress of SBMFC, Brazilia, June 2011. (PDF; 461 kB)
Marc Jamoulle: la prévention quaternaire, une tâche explicite du médecin généraliste. In: Prospective Jeunesse. 2012, pp. 7-11. (PDF; 340 kB)
Julien Nève, Marc Jamoulle: Quaternary prevention, an explicit task of the physician. Oct 25, 2012. (PDF; 505 kB)
J. Gérvas: Prevención cuaternaria en ancianos. In: Rev Esp Geriatr Gerontol. 47 (6), 2012, pp. 266-269. (PDF; 189 kB)
Quaternary Prevention (P4). In: Revista Brasileira de Medicina de Família e Comunidade. 10 (35), 2015.

Web links

Individual evidence

↑ J. Gervás: La prevención cuaternaria. ( Memento of July 26, 2011 in the Internet Archive ) In: OMC. 95, 2004, p. 8.
↑ M. Jamoulle: About prevention; the quaternary prevention. In: UCL. 2008.
↑ ^a ^b T. Kühlein, D. Sghedoni, G. Visentin, J. Gervàs, M. Jamoule: quaternary prevention, a task for general practitioners. ( Memento from August 30, 2011 in the Internet Archive ) In: PrimaryCare. 10 (18), 2010, pp. 350-354.
↑ M. Jamoulle: Quaternary prevention, an answer of family doctors to overmedicalization. In: International Journal of Health Policy and Management. 4, February 4, 2015, pp. 1-4.
↑ Marc Jamoulle
↑ M. Jamoulle: Information et de médecine générale informatization. In: J. Berleur, C. Labet-Maris, RF Poswick, G. Valenduc, Ph. Van Bastelaer: Les informa-g-iciens. Namur (Belgique): Presses Universitaires de Namur. 1986, pp. 193-209.
^ Quaternary prevention. (PDF; 79 kB) Thomas Baumann, Editorial, Pediatrics up2date 2012.
^ N. Bentzen (Ed.): WONCA Dictionary of general / family practice. ( Memento from June 30, 2012 in the web archive archive.today ) Maanedskift warehouse, Copenhagen 2003.
^ T. Greenhalgh, B. Hurwitz (Eds.): Narrative based Medicine - Dialogue and Discourse in Clinical Practice. BMJ Books, London 1998.

[1] J. Gervás: La prevención cuaternaria. ( Memento of July 26, 2011 in the Internet Archive ) In: OMC. 95, 2004, p. 8.

[2] M. Jamoulle: About prevention; the quaternary prevention. In: UCL. 2008.

[Kuehlein-3] T. Kühlein, D. Sghedoni, G. Visentin, J. Gervàs, M. Jamoule: quaternary prevention, a task for general practitioners. ( Memento from August 30, 2011 in the Internet Archive ) In: PrimaryCare. 10 (18), 2010, pp. 350-354.

[4] M. Jamoulle: Quaternary prevention, an answer of family doctors to overmedicalization. In: International Journal of Health Policy and Management. 4, February 4, 2015, pp. 1-4.

[5] Marc Jamoulle

[6] M. Jamoulle: Information et de médecine générale informatization. In: J. Berleur, C. Labet-Maris, RF Poswick, G. Valenduc, Ph. Van Bastelaer: Les informa-g-iciens. Namur (Belgique): Presses Universitaires de Namur. 1986, pp. 193-209.

[7] Quaternary prevention. (PDF; 79 kB) Thomas Baumann, Editorial, Pediatrics up2date 2012.

[8] N. Bentzen (Ed.): WONCA Dictionary of general / family practice. ( Memento from June 30, 2012 in the web archive archive.today ) Maanedskift warehouse, Copenhagen 2003.

[9] T. Greenhalgh, B. Hurwitz (Eds.): Narrative based Medicine - Dialogue and Discourse in Clinical Practice. BMJ Books, London 1998.