Quaternary Prevention: Is this Concept Relevant to Public Health? A Bibliometric and Descriptive Content Analysis

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. 28% of the papers were published in Q1 or Q2 journals. The research outputs on P4 begun first in the South of Europe, went to South America and then expanded worldwide. 88% of the articles were bibliographic research and 38% of all focused on specific examples of medical overuse (including several screening tests). Conclusions: Quaternary prevention represents an ethical and valid approach to prevent occurence of iatrogenic events and to achieve equal and fair access to health services. Conceptual, geographical and linguistic elements, as well as WONCA conferences and type of healthcare systems in the authors' country were fundamental factors that affected research output. The quality and quantity of available studies is still limited, therefore further investigations are recommended to assess the effective impact of P4 on public health.

Prevenção quaternária, reforma curricular e educação médica

“…Quanto aos eventos iatrogênicos, uma hipótese razoável é a de que estes não se apresentam de forma evidente porque ainda são pouco estudados, divulgados e discutidos nas instituições de ensino 5 . Nesse contexto de referência, a compreensão da P4 como tecnologia leve para o enfrentamento dos problemas de superutilização de serviços de saúde e epidemia de intervenções médicas excessivas pode significar uma etapa necessária para atingir os resultados esperados: melhorias significativas nos indicadores de sucesso clínico; e fortalecimento da relação entre usuário e profissional de saúde, ampliando a importância do vínculo terapêutico e aprimorando a alocação dos recursos da saúde 31 .…”

“…Esse contexto epidemiológico preocupante foi propício para revelar uma proposta relevante e inovadora para a Saúde Pública: a prevenção quaternária (P4) 4 . O conceito, inicialmente proposto pelo médico de família belga Marc Jamoulle no fim da década de 1980, visa enfrentar a problemática da medicalização excessiva ou sobremedicalização com o intuito de impactar a iatrogenia clínica e "representa um combate ético para alcançar um acesso e uma organização justa e equânime dos serviços de saúde" 5 .…”

Quaternary prevention. Prediabetes: risk, disease or overdiagnosis? The diseases which are not of great danger should not be teased by medicines (Plato, 5th century BC)

“…2,[6][7][8] On je temelj susreta paci jenta i liječnika obiteljske medicine, ali treba biti sa stavnica svih razina zdravstvene zaštite. 6,8,9 U odnosima između liječnika i pacijenta P4 je više usmjeren liječniku, potiče strukturirani (zatvoreni) nadzor, raspravu prema određenim aktivnostima teme ljenima na dokazima prema principu "najprije ne šte titi".…”

“…Smje rovi razvoja P4 jesu utvrđivanje situacija koje vode u suvišnu dijagnozu, intervenciju i medikalizaciju, raz vijanje komunikacijskih vještina i kritičko stajalište prema smjernicama i sukobu interesa, nalaženje za mjena za nepotrebnu medicinsku intervenciju i razvoj alata za identifikaciju P4 u zaštiti te za mjerne instru mente ishoda P4. 2,9 Problemi s dijagnozama temeljenima na kontinuira noj varijabli jesu kako odrediti prijelomnu točku i što učiniti s graničnim vrijednostima. Granične su vrijed nosti temelj pojma predbolesti pa se tako govori i o stanju koje prethodi dijabetesu, tj.…”