The quaternary prevention in the work of primary health care physicians: literature review

Abstract

The concept of quaternary prevention was integrated in 1999. into the international WONCA vocabulary as actions taken to identify patients at risk of overprescribing drugs and diagnostic procedures that would do them more harm than good. The aim was to determine the place and role of quaternary prevention in primary care. The papers published until 31.12.2022. have been analyzed. We searched Medline, PubMed, Cochrane Library, Scopus, Google Scholar, Science Direct, Mendeley, Serbian medical journals, books, strategies, and doctoral theses. The terms we used were: quaternary prevention, general medicine, overmedication, and diagnostic procedures. We restricted ourselves to works written in Serbian, English, and Croatian. Search has been performed from 01.09.2022. to 31.12.2022. Preferred Reporting Items for Systematic Review (PRISMA) scale parts were used to determine the validity of the papers collected. A total of 1899 papers were identified. We did not find meta-analyses, systematic literature reviews, and randomized studies. A total of 194 were analyzed. Highlighted as relevant 36. Quaternary prevention in primary care refers to the overuse of radiological and laboratory examinations, antibiotics, screening, individual patient access, good communication, reliance on evidence-based medicine, the workload in teams of selected doctors, and prompt consent to patient requests. Some sick patients are undiagnosed, concerned about their health, with functional problems, psychosomatic disorders, and unusual behavior during illness. Quaternary prevention has a place in breast and prostate cancer screening, immunization, mental health and osteoporosis drug marketing, hypertension, prediabetes, and dyslipidemia, a private health insurance program, and the use of high-resolution diagnostic technology. The most powerful way to avoid unnecessary medical procedures is to consistently apply evidence-based medicine.