DOCSLIB.ORG

Quaternary Prevention: a Balanced Approach to Demedicalisation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Quaternary Prevention: a Balanced Approach to Demedicalisation Life & Times Quaternary prevention: a balanced approach to demedicalisation In 1982, the Journal of the Royal College of General Practitioners published Ivan Illich’s “The main problem of overdiagnosis is overtreatment: article ‘Medicalization in Primary Care’.1 Illich held a paradoxical belief that GPs treating pseudo-diseases that bear no prospect of could contribute to the healthy process of benefit.” demedicalisation, that is: ‘... to offer their patients the occasion to patients end up dying from competing 10 years.7 This increases the overdiagnosis de-medicalize their own attitude to pain, diseases and not gaining in longevity. effect and offers minimal individual benefit. disability, discomfort, ageing, birth and The main problem of overdiagnosis is Regarding P2, there are lots of instances 1 death.’ overtreatment: treating pseudo-diseases of overmedicalisation due to non-evidence- that bear no prospect of benefit.6 This based screening for thyroid, prostate, and In other words, ‘unhooking [patients] represents harm both to individuals’ ovarian cancers. Breast cancer screening 1 from the health system’. This article wellbeing and to health systems as also needs to be readdressed. After an presents WONCA’s definition of Quaternary it generates unnecessary costs and average of two decades of breast cancer Prevention (P4) as a unifying framework that waste of resources. Potential sources screening in Canada8 and the US,9 there 2 organises GPs’ scope on demedicalisation. of overdiagnosis are disease screening, are considerable overdiagnosis rates altering cut-off points for defining a risk (roughly 30%), minimal (if any) impacts on EXPLAINING QUATERNARY PREVENTION factor or a disease, and financial incentives mortality,10 but known potential harms such Devised in 1986 by Marc Jamoulle, a (for example, pay-for-performance as an increase in heart disease (27%) and Belgian GP, P4 is: schemes).5 lung cancer (78%) mortality.11 Concerning P3, diabetes care provides a ‘... an action taken to identify a patient at FIRST DO NO HARM good example. The belief in ‘the lower the risk of over-medicalization, to protect him An example of controversial P1 is better’ Hb1Ac levels has potentially done from new medical invasion, and to suggest prescription of statins for individuals more harm than good due to polypharmacy, to him interventions which are ethically reduction in quality of life, and an increase in acceptable.’ 3 with 10% cardiovascular mortality risk in P4 was initially oriented to those patients who were feeling ill, but who Box 1. Quaternary prevention framework as an organising principle for had no clinically established disease: the demedicalisation worried well and those presenting with Clinicians’ perspective (biomedical gaze) medically unexplained symptoms.3 The No disease Disease Demedicalisation former are concerned about their health P1 P2 P1 and P2 originally belong status and usually demand check-ups; the to public health tradition, as An action taken to avoid or An action taken to detect a latter present with symptoms that lack they deal with population remove the cause of a health health problem at an early pathophysiological explanations. Some of outcomes. Patients need problem in an individual or stage in an individual or these symptoms stem from psychosocial to be informed about population before it arises. population, thereby facilitating Feeling potential harms of each circumstances. Both groups of patients are It includes health promotion its cure, reducing or 4 well specific intervention due subjected to overmedicalisation. and specific protections (for preventing its spreading, to overdiagnosis and Box 1 provides a framework that organises example, immunisation) and/or long-term effects (for overtreatment the scope of P4. Its clockwise-arrow at the example, screening and early centre indicates that P4 impacts the other diagnosis) three preventive levels: primary prevention Patients’ (P1), secondary prevention (P2), and tertiary perspective P4 P3 P3 and P4 are the realm of prevention (P3). Box 1 also differentiates two personalised clinical care. An action taken to An action taken demedicalisation scenarios: 1) P1 and P2, Clinicians’ art of relieving identify a patient or population to reduce the chronic effect which deals with symptomless individuals; patients’ suffering and/or at risk of overmedicalisation, of a health problem in an and 2) P3 and P4, which comprises disease/ reassuring their wellbeing to protect them from invasive individual or population by illness dimensions, merging clinical care Feeling medical interventions, and to minimising the functional with preventive activities. ill suggest interventions that are impairment of an acute or Individuals undergoing P1 and P2 ethically acceptable chronic health problem might be subjected to overdiagnosis and (for example, prevent the overtreatment (that is, overmedicalisation). consequences of diabetes), Overdiagnosis is ‘the diagnosis of a condition including rehabilitation that would have remained indolent in the patient’s lifetime if left undetected’.5 Thus, 28 British Journal of General Practice, January 2019 12 Armando Henrique Norman, mortality. Therefore, distinction between ADDRESS FOR CORRESPONDENCE clinical and preventive activities is essential Lecturer, Department of Internal Medicine, Federal University of Santa Catarina, Santa Catarina, Brazil. Armando H Norman to circumvent the excesses of biomedicine. Department of Internal Medicine, Federal University In prevention, the bioethical principle of of Santa Catarina; Campus Reitor João David non-maleficence should prevail as we Charles Dalcanale Tesser, Ferreira Lima, s/n —Trindade, Florianópolis — SC, Professor, Department of Public Health, Federal are dealing with healthy or asymptomatic 88040-900, Brazil. University of Santa Catarina, Santa Catarina, Brazil. Email: [email protected] people, and the oath First Do No Harm should guide GPs’ practice.13 P4 implies DOI: https://doi.org/10.3399/bjgp19X700517 an attitudinal shift of self-containment, caution, and reassurance of patients’ integrity when dealing with preventive REFERENCES 7. Redberg RF, Katz MH. Statins for primary interventions. It requires a critical appraisal 1. Illich I. Medicalization and primary care. J R prevention. JAMA Intern Med 2017; 177(1): 21. of current biomedical knowledge, inviting Coll Gen Pract 1982; 32(241): 463–470. 8. Miller AB, Wall C, Baines CJ,et al. Twenty five GPs to be more autonomous, proactive, and 2. Bentzen N. Wonca International Classification year follow-up for breast cancer incidence and mortality of the Canadian National Breast to follow protocol less slavishly. Committee. Wonca international dictionary for general/family practice. Copenhagen, Screening Study: randomised screening trial. 2003. http://www.ph3c.org/PH3C/ BMJ 2014; 348: g366. CONCLUSION docs/27/000092/0000052.pdf (accessed 3 Dec 9. Bleyer A, Welch HG. Effect of three decades of Quaternary prevention is a well-devised 2018). screening mammography on breast-cancer concept that embeds three main points: 3. Martins C, Godycki-Cwirko M, Heleno B, incidence. N Engl J Med 2012; 367(21): 1998– 2005. risk of overmedicalisation, patients’ Brodersen J. Quaternary prevention: reviewing the concept. Eur J Gen Pract 2018; 24(1): 10. Welch HG, Black WC. Overdiagnosis in cancer. protection, and ethical alternatives. This 106–111. J Natl Cancer Inst 2010;102: 605–613. definition is more comprehensive than the 4. Norman AH, Tesser CD. Quaternary 11. Gøtzsche PC, Jørgensen KJ. Screening for recent initiative to redefine it in terms of the prevention: the basis for its operationalization breast cancer with mammography. Cochrane harm/benefit ratio.3 P4 provides a platform in the doctor–patient relationship. Rev Bras Database Syst Rev 2013; (6): CD001877. 10(35): that may help GPs to realise the vital task Med Família e Comunidade 2015; 1. 12. Shaughnessy AF, Erlich DR, Slawson DC. Type of demedicalising by sorting out what can 5. Bulliard J-L, Chiolero A. Screening and 2 diabetes: updated evidence requires updated overdiagnosis: public health implications. decision making. Am Fam Physician 2015; or should be demedicalised in clinical care. Public Health Rev 2015; 36(1): 1–5. 92(1): 22. To realise this task, as paradoxically 6. Welch HG, Schwartz L, Woloshin S. 13. Tesser CD, Norman AH. Differentiating clinical envisioned by Illich, P4 needs support and Overdiagnosed: making people sick in the care from disease prevention: a prerequisite for further research to be globally disseminated pursuit of health. Boston, MA: Beacon Press, practicing quaternary prevention. Cad Saude in primary care. 2011. Publica 2016; 32(10): e00012316. British Journal of General Practice, January 2019 29.
Load more

Recommended publications
  • The Frail Elderly and Integral Health Management Centered on the Individual and the Family Editorial 307
    http://dx.doi.org/10.1590/1981-22562017020.170061 The frail elderly and integral health management centered on the individual and the family Editorial 307 The rapid aging of the Brazilian population, combined with an increase in longevity, has had serious consequences for the structure of health care networks, with an increased burden of chronic diseases and especially of functional disabilities. Unfortunately, the care offered to frail elderly people with multiple chronic health conditions, poly-disabilities or complex needs is fragmented, inefficient, ineffective and discontinuous, which can further harm their health. The hospital-based health system of the 19th and 20th centuries that is designed to deal with acute and especially infectious diseases is inadequate for meeting the needs of chronic patients for long-term, continuous treatment. The response of the health system to the new demands means the use of a set of management technologies that are capable of ensuring optimal standards of health care in a resolutive, efficient, scientifically structured manner, which is safe for patients and health professionals, timely, equitable, humanized and sustainable, is essential. The threefold goal of a better care experience, coupled with improved populational health and reduced costs developed by the Institute of Healthcare Improvement (Triple Aim), is the best strategy for reorganizing and optimizing health system performance. Providing the best care experience means understanding the particularities of health in the elderly. The use of parameters based on risk factors, diseases and/or age is inappropriate and is associated with a high risk of iatrogenic illness. Vitality is extremely heterogeneous among the elderly and chronological age is a precarious metric for the assessment of the homeostatic reserve of the individual.
    [Show full text]
  • Results of the Self-Assessment of Essential Public Health Operations Foreword
    The WHO Regional The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Ministry of Health of the Kyrgyz Republic Armenia Austria Azerbaijan Belarus Belgium Results of the self-assessment of Bosnia and Herzegovina Bulgaria Croatia essential public health operations Cyprus Czechia in the Kyrgyz Republic Denmark Estonia Finland April–September 2016 France Georgia Germany Greece Bishkek 2017 Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Uzbekistan Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 E-mail: [email protected] ABSTRACT This report presents the results of Kyrgyzstan’s self-assessment of the essential public health operations (EPHOs). The EPHO self-assessment was initiated by the Ministry of Health of the Kyrgyz Republic and conducted under the biennial collaborative agreement between the WHO Regional Office for Europe and the Government of Kyrgyzstan for 2016–2017. In addition to describing the assessment process, the technical report presents the key recommendations put forth by the Steering Committee and Specialized Teams. KEYWORDS ESSENTIAL PUBLIC HEALTH OPERATIONS HEALTH POLICY HEALTH SYSTEM PLANS – ORGANIZATION AND ADMINISTRATION HEALTH SYSTEM REFORM HEALTH SYSTEMS ASSESSMENT HEALTH SYSTEM STRENGTHENING PUBLIC HEALTH STRATEGY Address requests about publications of the WHO © World Health Organization 2017 All rights reserved.
    [Show full text]
  • Self-Assessment Tool for the Evaluation of Essential Public Health
    The WHO Regional Office for Europe SELF-ASSESSMENT TOOL FOR THE EVALUATION OF ESSENTIAL PUBLIC HEALTH OPERATIONS IN THE WHO EUROPEAN REGION The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Self-assessment tool for the Poland Portugal evaluation Republic of Moldova Romania Russian Federation of essential public health San Marino Serbia operations Slovakia Slovenia in the WHO European Region Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: [email protected] Website: www.euro.who.int Self-assessment tool for the evaluation of essential public health operations in the WHO European Region Abstract Through a process of extensive and iterative consultation, the WHO Regional Office for Europe devised 10 essential public health operations (EPHOs) that define the field of modern public health for the Member States in the WHO European Region. Formally endorsed by all of the Member States in the Region,the EPHOs form a comprehensive package that all Member States should aim to provide to their populations.The public health self-assessment tool presented here provides a series of criteria with which national public health officials can evaluate the delivery of the EPHOs in their particular settings.
    [Show full text]
  • National Cancer Institute University of Oxford
    SEPTEMBER 1-3, 2015 CO-SPONSORED BY NATIONAL CANCER INSTITUTE Division of Cancer Prevention UNIVERSITY OF OXFORD Centre for Evidence-Based Medicine NATCHER CONFERENCE CENTER National Institutes of Health | Bethesda, Maryland USA NOTICE OF PHOTOGRAPHY & FILMING Preventing Overdiagnosis 2015 is being visually documented. By your attendance you acknowledge that you have been informed that you may be photographed and recorded during this event . Images taken will be treated as property of Preventing Overdiagnosis and may be used in the future for promotional purposes. These images may be used without limitation by any organisation approved by the Preventing Overdiagnosis scientific committee and edited prior to publication as seen fit for purpose. Images will be available on the Internet, accessible to Internet users throughout the world including countries that may have less extensive data protection laws than partnering organisation countries. All films will be securely stored on the University of Oxford servers. Please make your- self known at the registration desk if you wish to remain off camera. Thank you for your cooperation. CONFERENCE PARTNERS The Dartmouth Institute Bond University, Centre for Research in Evidence-Based Practice The BMJ Consumer Reports University of Oxford, Centre for Evidence-Based Medicine The views expressed in these materials or by presenters or participants at the event do not necessarily reflect the official policies of the U.S. Department of Health and Human Services, the National Institutes of Health, the National Cancer Institute, or any NIH component. TABLE OF CONTENTS WELCOME 2015 Scientific Committee 4 KEYNOTES BIOS 6 PROGRAMME 16 KEYNOTE ABSTRACTS 32 WORKSHOP ABSTRACTS 34 SEMINAR ABSTRACTS 48 PANEL SESSION ABSTRACTS 61 POSTERS 66 NOTES 67 MAPS WELCOME We are pleased to welcome you to the 3rd Preventing Overdiagnosis conference, held in Bethesda, Maryland on the campus of the US National Institutes of Health.
    [Show full text]
  • Putting Prevention Into Practice Guidelines for the Implementation of Prevention in the General Practice Setting
    Putting prevention into practice Guidelines for the implementation of prevention in the general practice setting Third edition Over 20 years of improving preventive health activities racgp.org.au Healthy Profession. Healthy Australia. Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting. Third edition Disclaimer The information set out in this publication is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is this publication exhaustive of the subject matter. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates. Accordingly, The Royal Australian College of General Practitioners Ltd (RACGP) and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in this publication for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in this publication and whether caused by reason of any error, negligent act, omission or misrepresentation in the information. Recommended citation The Royal Australian College of General Practitioners. Putting prevention into practice: Guidelines for the implementation of prevention in the general practice setting.
    [Show full text]
  • Pharmaceutical Drug Misuse Problems in Australia: Complex Issues, Balanced Responses
    Pharmaceutical drug misuse problems in Australia: Complex issues, balanced responses Roger Nicholas Nicole Lee Ann Roche Pharmaceutical drug misuse problems in Australia: Complex issues, balanced responses Roger Nicholas Nicole Lee Ann Roche Suggested citation: Nicholas, R., Lee, N., & Roche, A. (2011). Pharmaceutical Drug Misuse in Australia: Complex Problems, Balanced Responses. National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide. ISBN: 978 1 876897 39 0 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the National Centre for Education and Training on Addiction, available from Level 3B Mark Oliphant Building, Science Park, Bedford Park, South Australia, 5042, Australia. Any enquiries about or comments on this publication should be directed to: Professor Ann Roche National Centre for Education and Training on Addiction (NCETA) Flinders University GPO Box 2100 Adelaide 5001 South Australia Australia. Published by the National Centre for Education and Training on Addiction (NCETA). www.nceta.flinders.edu.au Design and layout by Inprint Design www.inprint.com.au Foreword Over recent years, there has been growing awareness of potential harms that can result from the misuse of pharmaceutical drugs. This concern culminated in the decision by the Ministerial Council on Drugs (MCDS) through the Inter-Governmental Committee on Drugs (IGCD) to take decisive action to develop a comprehensive set of strategic responses. This task was overseen by Victorian Department of Health who in 2010 called for tenders to undertake the development of Australia’s first national strategy to address pharmaceutical drug misuse.
    [Show full text]
  • Conference Book
    2017 EACME Annual Conference “Justice in Health Care – Values in Conflict” September 7-9, 2017 Barcelona CONFERENCE BOOK ii Welcome to Barcelona Both the European Association of Centres of Medical Ethics (EACME) and the Borja Institute of Bioethics-Ramon Llull University (Barcelona) organize the 2017 EACME Annual Conference. The European Association of Centres of Medical Ethics (EACME) is, since its creation in December 1986, an international research and communication network with the aim to promote research, education and consultation in the field of (bio)- medical ethics. The Borja Institute of Bioethics-Ramon Llull University (Barcelona) was founded in 1976 with the main goal of studying in depth the problems raised by progress in biomedical science and its implications for society and its values, disseminating its findings in specialized publications. Recent developments in several countries in Europe, such as austerity measures, lead to concerns about the conflict between justice in health care with other eco- nomic and political values. That is why the Programme of 2017 EACME Annual Conference, under the topic \Justice in Health Care { Values in Conflict”, focuses on the following important issues: • Determinants of Health { What does health mean? Looking beyond WHO definition { Lifestyles and health { Quality of life { Social expectations and medicalisation of life { Salutogenesis and health-promotion activities • Healthcare Systems: at the Service of What? { Ethical issues in different models of Healthcare Systems { Sustainability
    [Show full text]
  • Quality in Prevention
    Quality in Prevention 8th EUSPR Conference and Members’ Meeting 20th - 22nd September 2017 Vienna, Austria EUSPR.ORG We are very pleased that the 2017 conference is co-organised and supported by the Austrian Federal Ministry of Health and Women’s Affairs and Gesundheit Österreich GmbH (GÖG), the Austrian Public Health Institute. The conference proceeds in collaboration with the Public Health Institute (PHI) at Liverpool John Moores University, UK; the State Agency for Prevention of Alcohol-Related Problems, (PARPA), PL; and the Dartington Social Research Unit (DSRU), UK. 22 Contents 04 Welcome 06 EUSPR 2017 co-organisers 06 Collaborating organisations 07 Conference acknowledgements 08 Programme at a glance 10 Plenary speaker biographies 12 Locations 16 Full Programme – Day 1 52 Full Programme – Day 2 87 Blank pages for notes 3 Welcome Dear EUSPR members and Conference Participants, This year’s annual EUSPR conference is held in Vienna, a real hub for quality in prevention internationally. The focus on quality in prevention at this year’s conference is therefore very apt, and this will further enhance the standing of the Society internationally as a beacon not only for the development and evaluation of prevention policies and interventions, but also for implementation, delivery and scaling up of prevention activities. The last three years have seen some steady progress and developments in the Society, including the successful launch of the Early Careers Network, the periodic EUSPR Newsletters, the establishment of the EC funded UPC-Adapt project, the completion of the EC funded SPAN initiative and integration of SPAN activities into the Society, the move of the Society from a base in Poland to a base in Spain, and more recently the beginnings of a new EUSPR forum for prevention policy makers and practitioners.
    [Show full text]
  • 1 Proposal to WONCA Executive Establish a Special Interest Group
    Proposal to WONCA Executive Establish a Special Interest Group on Quaternary Prevention and Overmedicalization Introduction: Justification and Importance “Medicine increasingly focuses on the problems that result from an excess of medical care, in particular overscreening and overdiagnosis. In a new framework or paradigm, based on patient doctor relationships, quaternary prevention (P4) describes the protection of patients from diagnostic tests, interventions and treatments that offer no benefit for overall morbidity or mortality for the individual, and may cause physical or psychological harm. It includes the protection of patients from misled well-meaning doctors and from a system in which the commercial interests of pharmaceutical and diagnostic companies, and governments working in a marketised model of health care, that can distort care, medicalize normal life and waste resources”. Jamoulle M, Mangin D (not published). Definitions The original definition of Quaternary Prevention was formulated in 1986 Action taken to identify patient at risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.1 WONCA International Dictionary of General/Family Practice, accepted the term in 1999.2 The concept of quaternary prevention is grounded in the ethical principles of medicine, an epistemological understanding of a paradigm crisis or struggle that is challenging the predominant biological paradigm in health, and the realization of a movement that includes citizens, patients, care providers and public health policies. Quaternary prevention provides a complex but necessary approach oriented to provide person -focused care; promote equity in healthcare; prevent overdiagnosis, unnecessary interventions, and avoid harm: and so, in few words, to humanize medicine.
    [Show full text]
  • (Iha) Meeting Report
    Justification of the Use of CT in Asymptomatic People for Individual Health Assessment (IHA) 26-28 September 2016, Seoul, Korea Workshop organized by the World Health Organization (WHO), in cooperation with the Korean Society of Radiology (KSR) and the Korean National Evidence-based Healthcare Collaborating Agency (NECA) MEETING REPORT 1. Introduction Constant innovation of health technology has expanded the applications of radiation in medical imaging and improved patient care. The justification of such exposures is based on the judgment that the clinical benefit of the medical imaging procedure will outweigh the radiation detriment. The established scenario for medical imaging in many parts of the world involves a patient with signs and/or symptoms being referred to a radiological procedure. In this scenario, the healthcare service is provided to people with a clinical condition to determine the presence or absence of disease, as a basis for making further treatment decisions. In this scenario, evidence-based imaging referral guidelines developed for a number of clinical conditions can support the justification process and enhance appropriateness of referrals by informing referrers and radiologists of the most appropriate examination. The scenario is different when medical imaging is performed on apparently healthy people (i.e. asymptomatic people) to detect early disease or risk factors for disease. In this context, medical imaging may take place within a formal population screening program (e.g. national mammography screening programs) or as an individual health assessment (IHA). The present workshop was built upon the outcomes of an expert consultation kindly hosted by Bundesamt fur Strahlenshutz (BfS) in Munich, Germany, in October 20141Error! Reference source not found.
    [Show full text]
  • Quaternary Prevention and Medicalisation: Inseparable Concepts
    https://www.interface.org.br eISSN 1807-5762 Articles Quaternary prevention and medicalisation: inseparable concepts Prevenção quaternária e medicalização: conceitos inseparáveis (resumo: p. 15) Prevención cuaternaria y medicalización: conceptos inseparables (resumen: p. 15) Charles Dalcanale Tesser(a) (a) Departamento de Saúde Pública, Centro de Ciências <[email protected]> da Saúde (CCS), Universidade Federal de Santa Catarina Armando Henrique Norman(b) (UFSC). Campus Universitário, <[email protected]> Rua Engenheiro Agronômico Andrei Cristian Ferreira, s/n, Trindade. Florianópolis, SC, Brasil. 88040-900. (b) Departamento de Clínica Médica, CCS, UFSC. Florianópolis, SC, Brasil. Quaternary Prevention (P4) is an action taken to identify patients at risk of overmedicalisation, to protect them from new medical invasions, and to suggest interventions ethically acceptable. Recently, three European articles have proposed a new definition: “to protect individuals from more harmful than beneficial interventions”. The objective is to discuss this proposal critically. We have identified and analysed seven criticisms to P4 original definition. Five are unfounded: (1) Ethically vague; (2) Restricted scope; (3) Creation of an unnecessary step; (4) Focus on medicalisation; (5) Demedicalisation non-scientific based. The remaining two do not justify a new definition: (6) Changing visual representation; (7) Centeredness on Evidence-Based Medicine (EBM). The new proposal reduces the scope of P4 and the professional role. The original definition is robust and incorporates the challenge of social/cultural iatrogeny resulting from overmedicalisation, partially unattainable via EBM. Keywords: Quaternary prevention. Family practice. Medicalisation. Evidence-based medicine. Primary health care. Tesser CD, Norman AH. Quaternary prevention and medicalisation: inseparable concepts. Interface (Botucatu). 2021; 25: e210101 https://doi.org/10.1590/interface.210101 1/15 Quaternary prevention and medicalisation: inseparable concepts ..
    [Show full text]
  • Quaternary Prevention: Is This Concept Relevant to Public Health? a Bibliometric and Descriptive Content Analysis
    medRxiv preprint doi: https://doi.org/10.1101/19007526; this version posted November 5, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. 1 Quaternary Prevention: Is this Concept Relevant to Public Health? A Bibliometric and Descriptive Content Analysis. Miguel Andino Depallens1 Jane Mary de Medeiros Guimarães1 Naomar Almeida Filho2 1 Federal University of the South of Bahia (UFSB) 2 Federal University of Bahia (UFBA) Abstract Objective To measure and map research output on Quaternary Prevention (P4) and outline research trends; to assess the papers content, mainly regarding methods and subjects approached in order to contribute to the improvement of global knowledge about P4 and to evaluate its relevance for public health. Design Bibliometric and descriptive content analysis. Articles reviewed Scientific articles about P4 recorded in Pubmed, LILACS, Scielo or CINAHL published until August 2018, with correspondent full articles available in Portuguese, English, Spanish, German or French. Main outcome measures Year of publication, first authors’ name and nationality, journals’ name, country and ranking, publication language, used methods and main reported subjects. Results 65 articles were included, published in 33 journals of 16 countries between 2003 and 2018 with a peak of publications in 2015. The first authors came from 17 different countries, 23% of them were Brazilian and Uruguay was the leading nation according to the scientific production per capita. 40% of all the selected articles were in English, 32% in Portuguese, 26% in Spanish.
    [Show full text]