Quaternary Prevention: What Is It?

Quaternary prevention is a highly 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.

The truth is that, as time passes and new technological advances emerge, it is clear that we require quaternary prevention. As we will see throughout the article, it depends on its correct application that medical resources reach everyone in good quality.

Quaternary prevention has been defined as actions that are carried out to avoid an overuse of medical resources by health professionals and patients. This includes avoiding overtreatment, avoiding unnecessary practices, and offering ethical alternatives.

The year 1986 is marked as the beginning of the idea of ​​quaternary prevention, when different medical researchers warned about the existence of a medicalization of everyday life. The process has run its course, despite the warnings.

We must clarify that this prevention does not aim to eliminate the availability of medical advances, but to rationalize. For this reason, patients are involved in the process, since the doctor is one more link in the long chain that supports the medicalization of everyday life.

And, ultimately, it is intended to provide security to patients. None of us would like to go through a therapeutic fury, or to be made to spend more money than we have in vain.

The types of prevention

This idea has been called quaternary prevention because prevention activities are considered staggered:

• Primary: it is the prevention that is carried out with people who are not yet sick. It seeks to prevent them from getting sick.
• Secondary: it is the early diagnosis. A person has a disease, but does not know it, because he has not yet developed symptoms. If we detect it in time, we will improve the prognosis.
• Tertiary: it is already about sick people. The best available treatment is proposed here to avoid fatal outcomes and consequences that are sequelae and alter the quality of life in the future.

• Quaternary: finally, the one that interests us in this article is prevention that limits the indiscriminate use of medical resources.

Examples of medical abuse

We may better understand quaternary prevention with examples of how medical resources are abused. Although we do not notice it clearly, the medicalization of what happens around us has become constant.

Among the abuses is the excess of tests requested to detect pathologies. Some primary prevention tests are indicated, but there are others that do not have scientific support.

On the other hand, questions that are sometimes taken for granted, are refuted before the advancement of science. Mammography, for example, has precise ages of indication in women, and it makes no sense to advance them and perform them in very young women just in case.

Let’s also think about the radiation we undergo when we get X-rays or CT scans. The abuse in the request of images could cause an increase in pathologies linked to radiation.

Treatments are not alien to this. It is very common for antibiotics to be prescribed for viral infections, generating bacterial resistance and adverse effects in patients. By adding adverse effects, the initial situation, which was perhaps simple, worsens and becomes more complicated.

Polypharmacy is one more example. There are elderly people subjected to a battery of daily pills that interact with each other without improving the quality of life. As each specialist in a different organ prescribes a specific drug, nobody checks if there will be a mixture between the effects of one and the other.

How to do quaternary prevention?

It is logical, then, to ask how to do quaternary prevention. Part of the task must be carried out by doctors, and part by patients. It is essential not to confuse primary prevention with treatments.

When a person wants to know their health, they do not necessarily have to take a medication with them. Nor should you go through a whole series of procedures that will not result in benefits.

New technology does not always mean better technology. Today there are antibiotics created decades ago that are more efficient than the new ones, cheaper and less harmless.

Mental health does not escape the problems of medicalization. There are many children diagnosed with attention deficit / hyperactivity disorder who do not actually meet the criteria. These children must undergo a series of measures that are taken towards them totally counterproductive.

It is not something that will change immediately, from one day to the next, but it must be a path to take. Quaternary prevention can give us more security as patients  and make medical resources available to everyone, without predating them.