Quaternary prevention

Medical diagnostics
Purpose| identify patients at risk of overmedication

Quaternary prevention means avoiding unnecessary medical interventions. They are the actions taken to identify an individual at risk of overmedicalisation, to protect them from new medical invasion, and to suggest interventions which are ethically acceptable.[1][2] The term was coined by the Belgian general practitioner Marc Jamoulle,[3]

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

## Contents

* 1 Definition
* 2 Per Jamoulle
* 3 See also
* 4 References
* 5 Further reading

## Definition

The Wonca International Dictionary for General/Family Practice defines it as "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]

Alternatively, quaternary prevention has been defined as an "action taken to protect individuals from medical interventions that are likely to cause more harm than good."[6]

## Per Jamoulle

Jamoulle divided medical situations into four quadrants based on if the patient was experiencing illness (i.e. if the patient experienced subjective poor health) [citation needed]and if a health care provider 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.[citation needed]

## See also

* Bioethics
* Cascade effect
* Defensive medicine
* Iatrogenesis
* Medical ethics
* Medicalization
* Medicine
* Patient safety
* Preventive medicine

## References

1. ↑ "Jamoulle M. About prevention; the Quaternary prevention. UCL. 2008". http://docpatient.net/mj/P4_citations.htm.
2. ↑ Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. International Journal of Health Policy and Management. 4-Feb-2015; 4:1–4.
3. ↑ 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.
4. ↑ Gervás J. La prevención cuaternaria. OMC. 2004;(95):8.
5. ↑ Bentzen, Niels (2003). Wonca dictionary of general/family practice. [S.l.]: Wonca International Classification Committee. p. 115. ISBN 8788638227. http://www.ph3c.org/ph3c/docs/27/000092/0000052.pdf. Retrieved 30 May 2022.
6. ↑ Martins, Carlos; Godycki-Cwirko, Maciek; Heleno, Bruno; Brodersen, John (January 1, 2018). "Quaternary prevention: reviewing the concept: Quaternary prevention aims to protect patients from medical harm" (in en). European Journal of General Practice 24 (1): 106–111. doi:10.1080/13814788.2017.1422177. ISSN 1381-4788. PMID 29384397. PMC 5795741. https://www.tandfonline.com/doi/full/10.1080/13814788.2017.1422177.

## 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
* 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.
* 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).

* v
* t
* e

Unnecessary health care

Causes|

* Direct-to-consumer advertising
* Overscreening
* Overdiagnosis
* Fee-for-service
* Defensive medicine
* Unwarranted variation
* Overmedication
* Overmedicalization
* Prescription cascade
* Quaternary prevention
* Disease mongering
* Political abuse of psychiatry

Overused health care|

* Caesarean delivery on maternal request
* Antibiotic misuse
* Benzodiazepine use disorder
* Effects of long-term benzodiazepine use
* Opioid use disorder
* Psychoactive drug
* Proton-pump inhibitor
* Polypharmacy
* treatment of incidentaloma

Tools and Situations|

* Deprescribing
* Choosing Wisely
* Medication discontinuation
* Withdrawal syndrome
* Antidepressant discontinuation syndrome
* Benzodiazepine withdrawal syndrome

Works about unnecessary health care|

* Overtreated
* The Treatment Trap
* Selling Sickness
* Overdosed America

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