title: Attitudes, perceptions and awareness concerning quaternary prevention among family doctors working in the Social Security System, Peru: a cross-sectional descriptive study.
abstract: BACKGROUND
  Quaternary Prevention is defined as the action taken to identify patients at risk of overtreatment, to protect them from additional medical treatments, and to suggest interventions that are ethically acceptable. Many countries and organizations have joined in the efforts to practice quaternary prevention. These countries started a campaign called Choosing Wisely that implements recommendations in order to avoid harming patients.
  
  
  OBJECTIVE
  To determine the attitudes, perceptions and awareness towards Quaternary Prevention and the practice of Choosing Wisely Canada Recommendations among family doctors working in the Social Security System in Peru.
  
  
  METHODS
  A questionnaire was developed after reviewing the literature and contacting experts in the field and was sent by email to all 64 family physicians in the Social Security System (Essalud) in Lima Peru. Responses were received from 40 participants.
  
  
  RESULTS
  The response rate was 64%. Approximately 95% reported that they understand the concept of quaternary prevention. Agreement with all the recommendations was 90% or higher. In most of the recommendations the applicability was more than 80%. The most important barriers perceived for the practice of Quaternary Prevention were patients expectations (33%).
  
  
  CONCLUSIONS
  There are positive perceptions towards Quaternary Preventions and Choosing Wisely recommendations in the family doctors of social security in Lima Peru.
authors.affiliation: Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú Address: Crane 130, Departamento 102, San Borja, Lima, Perú. Email: carlos.zegarra.z@upch.pe.
authors.forename: María Sofía
authors.initials: MS
authors.lastname: Cuba Fuentes
authors.affiliation: Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
authors.forename: Carlos Orlando
authors.initials: CO
authors.lastname: Zegarra Zamalloa
authors.affiliation: Department of Family Medicine and School of Health Studies, Western University, Ontario, Canada.
authors.forename: Sonja
authors.initials: S
authors.lastname: Reichert
authors.affiliation: Department of Family Medicine and School of Health Studies, Western University, Ontario, Canada.
authors.forename: Dawn
authors.initials: D
authors.lastname: Gill
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010465:Perception; D010568:Peru; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012943:Social Security; D011795:Surveys and Questionnaires
keywords: choosing wisely; family physician; quaternary prevention