Quaternary Prevention: What Is It?

Talking about quaternary prevention is difficult for doctors. It is also a subject often overlooked by patients. It is, to put it simply, to be careful and aware in the use of medical resources.

Quaternary prevention  is a much debated concept in the medical field. Many professionals are not in favor of its use as a guide for public health policies and some even deny its validity.

However, with the passing of time and new technological advances, it is evident that we need quaternary prevention. As we will see throughout this article,  the good quality of medical resources for all depends on their proper application.

Quaternary prevention has been defined as “actions which are carried out to avoid an overuse of medical resources on the part of health professionals and patients”. This therefore implies both avoiding an overflow of unnecessary treatments and practices, as well as offering ethical alternatives.

The year 1986 marked the birth of the idea of ​​quaternary prevention, when  several researchers in the field of medicine warned against a medicalization of everyday life. The process has run its course, despite the warnings.

We must stress that  this prevention does not aim to eliminate the availability of medical advances but to rationalize. This is why we involve patients in the process because the doctor is an additional step in the long chain which supports the medicalization of everyday life.

Ultimately,  we seek to provide patient safety. No one would like to endure therapeutic relentlessness or spend more money than necessary.

Types of prevention

This idea was given the name quaternary prevention because prevention activities are considered to be phased:

• Primary:  it is prevention that is carried out with people who are not yet sick. The goal is to prevent them from getting sick.
• Secondary:  this is the early diagnosis. A person has an illness but does not know it because they have not yet developed any symptoms. If we detect it in time, we improve its prognosis.
• Tertiary:  people are already sick. We offer here the best possible treatment to avoid a fatal outcome and sequelae that alter the quality of life in the future.
• Quaternary: this  is the one that interests us in this article. This is prevention that limits the indiscriminate use of medical resources.

Examples of medical abuse

It is possible to better understand quaternary prevention with examples of abuse of medical resources. Even though we don’t see it clearly,  the medicalization around us has become constant.

Among these abuses, we find the excess of examinations requested to detect pathologies. Some primary prevention reviews are indicated but others have no scientific justification.

In addition, questions that are sometimes taken for granted are refuted in the face of scientific progress. For example, mammography is recommended at specific ages in women and  there is no reason to do it earlier, in young women, just because we have doubts.

Let us also think about the rays to which we are subjected when we perform x-rays or computed tomography. Abuse of the demand for imaging tests could cause an increase in radiation-related pathologies.

The treatments are not unrelated to this. It is very common to prescribe antibiotics for viral infections, which generates bacterial resistance and side effects in patients. By adding side effects, the initial situation, which could be simple, ends up getting worse and more complicated.

Polypharmacy is another example. The elderly thus take a large number of medications on a daily basis which  interact with each other without improving the quality of life of the person. Since each specialist in a different organ prescribes a one-off drug, no one is trying to find out whether there will be a mixture of the effects of each other.

How to do quaternary prevention?

It is therefore logical to ask how we can do quaternary prevention. Part of this task has to be done by doctors, and part of it by patients. It is essential not to confuse primary prevention with treatment.

When a person wants to know more about their state of health,  they do not necessarily have to come out of the consultation with medication. Just as it does not have to go through a whole series of processes that will bring no benefit either.

New technology does not always mean better technology. Today, some antibiotics designed decades ago are more effective than newer, cheaper and more harmless ones.

Mental health is no exception to the problems of medicalization. Many children are diagnosed with Attention Deficit and Hyperactivity Disorder which, in reality, does not meet the criteria for them. These children have to go through a series of totally counterproductive measures.

It is not something that will change immediately, from one day to the next: a long road must be traveled. Quaternary prevention can offer us more safety as patients and ensure that medical resources are available to all, without abusing them.