Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec;24(1):106-111.
doi: 10.1080/13814788.2017.1422177.

Quaternary prevention: reviewing the concept

Carlos Martins  1 , Maciek Godycki-Cwirko  2 , Bruno Heleno  3 , John Brodersen  4
Affiliations

Quaternary prevention: reviewing the concept

Carlos Martins et al. Eur J Gen Pract. 2018 Dec.

Abstract

Background: According to the Wonca International Dictionary for General/Family Practice Quaternary Prevention is defined as: '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.' The concept of quaternary prevention was initially proposed by Marc Jamoulle and the targets were mainly patients with illness but without a disease.

Objectives: The purpose of this opinion article is to open the debate around a new possible definition and a new conceptual model of quaternary prevention based on the belief that quaternary prevention should be present in physicians' minds for every intervention they suggest to a patient.

Discussion: The debate around quaternary prevention is vital in the context of contemporary medicine and has expanded worldwide. The human being may suffer harm from medical interventions from conception, during their childhood, during their entire healthy lifetime as well as during a self-limited disease, a chronic disease, or a terminal disease. The current definition of quaternary prevention has limitations because it excludes patients and medical interventions where a quaternary prevention perspective would be needed and useful to protect patients from harm. In this context, a new definition and conceptual model of quaternary prevention is proposed.

Conclusion: In this new proposal, quaternary prevention is defined as an 'action taken to protect individuals (persons/patients) from medical interventions that are likely to cause more harm than good.'

Keywords: Prevention; health ethics; overdiagnosis; patient involvement (empowerment; quaternary prevention; self-management).

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Figures

Figure 1.
Figure 1.
Model of different categories of prevention in the relational model proposed by Marc Jamoulle. Adapted from the original with permission [7].
Figure 2.
Figure 2.
Illness and disease in relation to the four categories of prevention. Adapted from the original with permission [21].
See this image and copyright information in PMC

References

    1. Clark D, MacMahon B.. Preventive medicine. Boston (MA): Little, Brown & Co; 1967.
    1. Nightengale E, Cureton M, Kalmar V.. Perspectives on health promotion and disease prevention in the United States. Washington (DC): Institute of Medicine, National Academy of Sciences; 1978.
    1. Bentzen N. Wonca dictionary of general/family practice. Copenhagen: Manedsskrift for Praktisk Laegergerning; 2003.
    1. Hudson B, Zarifeh A, Young L, et al. . Patients’ expectations of screening and preventive treatments. Ann Fam Med. 2012;10:495–502. - PMC - PubMed
    1. Krouss M, Croft L, Morgan DJ.. Physician understanding and ability to communicate harms and benefits of common medical treatments. JAMA Intern Med. 2016;176:1565–1567. - PubMed

LinkOut - more resources