[Diagnostic and therapeutic activity moderation. Quaternary and genetic prevention].
Medical activities have more positive than negative outcomes. Because this balance, medicine has a great social recognition. But with new technology and more aggressive diagnostic and therapeutic interventions, there is a decreasing gap in between benefits and harms. Risk increases because more interventions, and because placing patients in more technology environments. As a consecuence, patient safety decreases. Quantity becomes as important as quality, and the place of care is crucial for patient safety. Medical activities should be of <<low intensity and high quality>>, performed in the low level of care possible. Then, quaternary prevention (to avoid unnecessary use and risk of medical interventions) should be a continuous parallel clinical activity. I consider four examples of needed quaternary prevention, with Spanish data: 1) cardiovascular prevention (where there is an inverse use of resources, as patients who need more receive less); 2) use of new antidepressants (which has provoke an artificial epidemic of <<depression"); 3) use of antibiotics (frequently, unnecessary use), and 4) genetic diagnosis (with the example of screening of haemochromatosis, and a commentary about genetics and medicalisation).
Gérvas
Juan
J
Equipo CESCA, Madrid, España. jgervasc@meditex.es
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D003933:Diagnosis; D004363:Drug Utilization; D030342:Genetic Diseases, Inborn / Q000517:prevention & control; D005820:Genetic Testing / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data / Q000639:trends; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011315:Preventive Medicine / Q000458:organization & administration*; D018570:Risk Assessment; D012449:Safety; D013812:Therapeutics / Q000009:adverse effects / Q000706:statistics & numerical data; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends
D000900:Anti-Bacterial Agents; D000928:Antidepressive Agents