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“Quaternary Prevention” or the Prevention of Unnecessary Medicine

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Thomas Kühlein, Thomas Maibaum, David Klemperer

Keywords: primary care quaternary prevention unnecessary medicine

Summary: Not everything that is statistically significant is clinically relevant. When statistical significance is confirmed, the question of relevance can be decided only individually in most cases. The decisive figure is the effect-size of a given measure. This article deals with quaternary prevention, which designates the prevention of irrelevant or unnecessary medicine. Small therapeutic effects can be meaningful for some patients while being superfluous for most. The discrimination between “illness” (suffering of the patient) and “disease” (diagnosis of the physician) allows a better understanding of the preventive tasks of primary care and facilitates the distinction between useful and unnecessary medicine. With the help of this discrimination, prevention can be classified into four forms. Primary prevention – medical interventions where the patient feels no illness, for example vaccinations. Secondary prevention – early detection measures in persons with risk factors but no disease. Tertiary prevention – preventing further deterioration in patients already affected by a disease. Quaternary prevention refers to the prevention of unnecessary medicine and should take place in those cases, frequent in primary care, in which patients suffer side, but doctors have not yet found adisease (important to be reluctant with diagnostics and therapy).


(State: 13.04.2018)

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