Quaternary prevention: First, do not harm

Kavukçu, Ethem; Akdeniz, Melahat

doi:10.15511/tahd.17.00274

Cited by 3 publications

(5 citation statements)

References 21 publications

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“…1 Koruma düzeyleri birincil, ikincil, üçüncül ve yeni bir alan olan dördüncül koruma kategorilerini kapsamaktadır . 2,3 Dünya Sağlık Örgütü, birincil korumayı "bir hastalığın ortaya çıkmasını önlemeyi amaçlayan eylemler" olarak tanımlar. Bu eylemler; sosyal ve ekonomik belirleyicilerin sağlık üzerindeki etkisini değiştirerek sağlığı iyileştirmeye yönelik faaliyetleri, davranışsal ve tıbbi sağlık riskleri hakkında bilgi sağlama ve danışmanlık hizmetini, kişisel ve toplumsal düzeyde beslenme ve gıda takviyesi; ağız ve diş hijyeni eğitimi; çocukların, yetişkinlerin ve yaşlıların aşılanması gibi klinik koruyucu hizmetleri, bulaşıcı hastalığa maruz kalan kişiler için aşılama veya maruz kalma sonrası profilaksiyi içermektedir .…”

Section: Koruma Ve Korunma Düzeyleriunclassified

quaternary prevention and over-medicalization

BÜYÜKOKUDAN,

AVCI

2023

Turkish Journal of Family Medicine and Primary Care

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Dördüncül koruma, aşırı tıbbi medikalizasyon riski altındaki kişilerin belirlenmesi ve hastaların gereksiz tıbbi müdahalelere karşı korunmalarını içerir. Günümüzde gelişen teknoloji ve artan sağlık hizmeti kullanımıyla beraber, hastalara gereksiz aşırı teşhis ve aşırı tedavi uygulanabilmektedir. Aşırı medikalizasyon kavramı ise, hastalara sağladığı faydalar açısından doğrulanmamış, potansiyel olarak zararlı ve bu nedenle gereksiz maliyetlere yol açan tıbbi uygulamalar olarak tanımlanmaktadır. Bunlar hastalarda sosyal, psikolojik ve ekonomik yönden olumsuz etkilenme; sağlık sisteminde ise memnuniyetsizlik ve ekonomik yükü arttırmaktadır. İnsanların tüm yaşamları boyunca tıbbi müdahalelerden zarar görebileceği düşünüldüğünde, dördüncül koruma ve aşırı medikalizasyon kavramı bu bağlamda büyük önem taşımaktadır. Aşırı medikalizasyonu azaltmak ve dördüncül korumayı sağlamak için; hastaların karar verme sürecine katılımı ve ortak karar alma, güvenilir hasta-hekim ilişkisi kurulması, birinci basamak sağlık hizmetlerinin teşvik edilmesi ve sevk sisteminin düzenlenmesi önem taşımaktadır.

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Section: Koruma Ve Korunma Düzeyleriunclassified

quaternary prevention and over-medicalization

BÜYÜKOKUDAN,

AVCI

2023

Turkish Journal of Family Medicine and Primary Care

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“…Quaternary prevention is also emphasized in the preventive healthcare framework, emphasizing the principle of "First, do no harm." [5] In the case that these measures are not taken, individuals may be at an increased risk of costly procedures requiring advanced research and invasive procedures in the future, as well as serious Cardiovascular (CV) complications that lead to mortality due to coronary artery stenosis. [6] Identifying the health-related risk factors of healthy individuals and implementing preventive medicine practices, such as lifestyle changes, before the onset of illness, is a simple, practical, and most effective method.…”

Section: Introductionmentioning

confidence: 99%

“…[ 3 , 4 ] Preventive healthcare is crucial in family medicine, encompassing 5 types of prevention: primordial prevention, primary prevention, secondary prevention, tertiary prevention, and quaternary prevention. [ 5 ] Primordial prevention involves measures and actions to decrease or eliminate risk factors for diseases within the community. Primary prevention includes activities targeting behavioral changes, reducing exposure to disease-causing factors, managing risky situations, and decreasing disease incidence.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Make your choice: Angiography or periodical health examination?

Yilmaz,

Çakmak,

Öztürk

et al. 2024

Medicine

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Periodical health examination is one of the important factors influencing a healthy lifestyle. Patients undergoing routine physical examination in primary care are included in the scope of preventive medical services, which is the most basic principle of primary care. Identifying the risk factors enables individuals to adopt healthier lifestyle practices. In our study, we examined the correlation between patients undergoing coronary angiography for suspected coronary stenosis and the extent of primary care services they had received in their medical history, along with the severity of stenosis observed during the angiography. Patients were interviewed using a pre-structured questionnaire to gather information about their past utilization of primary healthcare services related to coronary matters and their cardiovascular (CV) risk profile as documented in their medical history. The necessary standard tests for angiography procedures were retrieved from patient records. The SYNTAX score, a tool that aids in the objective assessment of the severity of coronary artery disease (CAD), was computed and documented. This score was then compared with the history of primary care utilization. The patients’ utilization of services from the Primary Healthcare Center (PHC) was evaluated using a scoring system, with an average score of 29.27 ± 11.27 out of 100 points (minimum: 20; maximum: 60). The average SCORE Türkiye indicating the 10-year risk of CV events for all patients was calculated as 14.31% ± 8.65% (high—very high risk), while the average SYNTAX score was 15.20 ± 9.97. There was a positive and significant correlation found between fasting blood glucose and creatinine values with both SYNTAX score and SCORE Türkiye (respectively; R = 0.238, P = .013; R = 0.289, P = .002). Factors such as smoking and metabolic syndrome were associated with CAD severity. It important to highlight that individual recommended for angiography had a notably lower utilization of healthcare services from the PHC based on their medical histories. This circumstance has resulted in individuals who do not undergo CV event screenings at PHCs having higher SYNTAX scores, indicating more severe CAD that necessitates angiography. Conducting regular periodical health examinations at PHCs can help mitigate these statistics.

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“…According to the principle of “first, do no harm,” which is one of the main ethical criteria of the medical profession, it is necessary to avoid iatrogenic damages due to over-screening, diagnosis, and over-treatment when applying preventive health services. This situation brought about the concept of quaternary protection that supports rational drug use ( 26 , 27 ). The concept of “deprescribing” refers to the gradual discontinuation of PIMs, and it is supervised by a healthcare professional.…”

Section: Introductionmentioning

confidence: 99%

Artificial intelligence-supported web application design and development for reducing polypharmacy side effects and supporting rational drug use in geriatric patients

Akyon

Akyon²,

Yılmaz³

2023

Front. Med.

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IntroductionThe main complications of polypharmacy, which is known as the simultaneous use of more than five drugs, are potentially inappropriate medicines(PIMs), drug–drug, and drug-disease interaction. It is aimed to prepare an auxiliary tool to reduce the complications of polypharmacy and to support rational drug use(RDU), by evaluating the patient with age, drugs, and chronic diseases in this study.Materials and methodsIn the first phase of this study, as methodological research, an up-to-date and comprehensive auxiliary tool as a reference method was generated with a database containing interaction information of 430 most commonly used drug agents and chronic diseases in geriatrics in the light of current and valid 6 PIM criteria for geriatric patients, and medication prospectuses, relevant current articles, and guidelines. Then, an artificial intelligence(AI) supported web application was designed and developed to facilitate the practical use of the tool. Afterward, the data of a cross-sectional observational single-center study were used for the rate and time of PIM and drug interaction detection with the web application. The proposed web application is publicly available at https://fastrational.com/.ResultsWhile the PIM coverage rate with the proposed tool was 75.3%, the PIM coverage rate of EU(7)-PIM, US-FORTA, TIME-to-STOPP, Beers 2019, STOPP, Priscus criteria in the web application database respectively(63.5%–19.5%) from the highest to the lowest. The proposed tool includes all PIMs, drug–drug, and drug-disease interaction information detected with other criteria. A general practitioner detects interactions for a patient without the web application in 2278 s on average, while the time with the web application is decreased to 33.8 s on average, and this situation is statistically significant.DiscussionIn the literature and this study, the PIM criteria alone are insufficient to include actively used medicines and it shows heterogeneity. In addition, many studies showed that the biggest obstacle to drug regulation in practice is “time constraints.” The proposed comprehensive auxiliary tool analyzes age, drugs, and diseases specifically for the patient 60 times faster than the manual method, and it provides quick access to the relevant references, and ultimately supports RDU for the clinician, with the first and only AI-supported web application.

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Quaternary prevention: First, do not harm

Cited by 3 publications

References 21 publications

quaternary prevention and over-medicalization

quaternary prevention and over-medicalization

Make your choice: Angiography or periodical health examination?

Artificial intelligence-supported web application design and development for reducing polypharmacy side effects and supporting rational drug use in geriatric patients

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