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四级预防:概念回顾。

Quaternary prevention: reviewing the concept.

机构信息

a Family Medicine, Department of Community Medicine, Information and Decision in Health (MEDCIDS) of the Faculty of Medicine of Porto , Centre for Health Technology and Services Research (CINTESIS) , Porto , Portugal.

b Division of Public Health, Centre for Family and Community Medicine , Medical University of Lodz , Lodz , Poland.

出版信息

Eur J Gen Pract. 2018 Dec;24(1):106-111. doi: 10.1080/13814788.2017.1422177.

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.'

摘要

背景

根据世界家庭医生组织国际词典,四级预防被定义为:“采取行动识别有过度医疗化风险的患者,保护其免受新的医疗侵害,并向其建议符合伦理的可接受的干预措施。”四级预防的概念最初由马克·雅穆尔提出,其目标主要是患有疾病但尚未患病的患者。

目的

本文的目的是就基于这样一种信念的四级预防的新定义和新概念模型展开讨论,即四级预防应该存在于医生对患者提出的每一项干预措施的考虑中。

讨论

在当代医学背景下,四级预防的讨论至关重要,并且已经在全球范围内展开。人类可能会因医疗干预而在受孕时、儿童时期、整个健康生命周期以及自限性疾病、慢性疾病或终末期疾病期间受到伤害。当前的四级预防定义存在局限性,因为它排除了需要和有用的四级预防视角的患者和医疗干预措施,以保护患者免受伤害。在这种情况下,提出了新的四级预防定义和概念模型。

结论

在这个新的提议中,四级预防被定义为“采取行动保护个人(个体/患者)免受可能弊大于利的医疗干预措施的影响”。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bbe2/5795741/be6b7c0dd94a/IGEN_A_1422177_F0001_C.jpg

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