What is Quaternary Prevention?

Talking about quaternary prevention is difficult for physicians and often unknown to patients. Basically, it's about being prudent and conscientious in the use of medical resources. Keep reading to learn more about this important concept.
What is Quaternary Prevention?
Leonardo Biolatto

Written and verified by the doctor Leonardo Biolatto.

Last update: 27 May, 2022

Quaternary prevention is the subject of a lot of discussion in the medical field. Many professionals aren’t in favor of its use as a guide for public health policies, and some even deny its validity.

The truth is that, as time goes by and new technological advances emerge, it’s clear that we need quaternary prevention. As we’ll see throughout this article, the availability of quality medical resources for all depends on the correct application of quaternary prevention.

Quaternary prevention has been defined as actions taken to avoid the overuse of medical resources by health professionals and patients. This includes avoiding overtreatment, avoiding unnecessary practices, and offering ethical alternatives.

The year 1986 was the starting point for the idea of quaternary prevention. At that time, various medical researchers warned of the medicalization of everyday life. The process has continued, despite the warnings.

We should clarify that this prevention doesn’t aim at eliminating the availability of medical advances. Rather, it aims at rationalizing it. For this reason, it involves patients in the process, since physicians are one more link in the long chain that sustains the medicalization of everyday life.

And, ultimately, the aim is to provide patients with security. None of us would like to be subjected to therapeutic incarceration or to be made to spend more money than necessary.

Types of prevention

We refer to this concept as quaternary prevention because prevention activities are considered to be staggered:

  • Primary: This is prevention that applies to people who aren’t yet ill. The aim is to prevent them from becoming ill.
  • Secondary: Early diagnosis. A person has a disease but doesn’t know it, because they haven’t yet developed symptoms. If we detect it in time, we improve the prognosis.
  • Tertiary: We’re already dealing with sick people. Here, doctors suggest the best available treatment to avoid fatal outcomes and negative consequences that alter a patient’s future quality of life.
  • Quaternary: Finally, the type that interests us in this article, is the prevention that limits the indiscriminate use of medical resources.
A female doctor writing a prescription.
Physicians, fundamentally, must take on quaternary prevention as their own task.

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Examples of medical abuse

We may understand quaternary prevention better with examples of the abuse of medical resources. Although we may not notice it clearly, the medicalization of what goes on around us has become constant.

Among the abuses is the requesting of excess tests to detect diseases. Sometimes some primary prevention tests are necessary, but others have no scientific basis.

On the other hand, issues that should be common knowledge are refuted in the face of scientific progress. Mammograms, for example, are meant for women of precise ages and it doesn’t make sense to push them forward and perform them in very young women just for the sake of doubt.

Let us also think about the radiation to which x-rays or CT scans expose us. Abuse in requesting images could cause an increase in radiation-related pathologies.

Medical treatments are no exception to this problem. It’s very common for doctors to prescribe antibiotics for viral infections, thus producing bacterial resistance and adverse effects in patients. By adding adverse effects, the initial situation, which may have been simple, worsens and becomes more complicated.

Polymedication is another example. Some elderly people take to a battery of daily pills that interact with one another without improving the quality of life. Since each distinct specialist prescribes a specific drug, no one checks whether there will be a combination between the effects of one and another.

A doctor handing a patient a variety of medications.
Polymedication is common in older adults, without considering the consequences.

Find out more: The Expiration Date of Medicine: Does Effectiveness Decrease?

How do doctors carry out quaternary prevention?

It’s logical, then, to ask how to carry out quaternary prevention. Part of the task belongs to physicians and another part to patients. That said, it’s essential not to confuse primary prevention with treatment.

When a person wants to know their health status, they don’t necessarily have to take their medication with them to the doctor’s office. Nor do they have to go through a whole series of procedures that won’t lead to any benefits.

New technology doesn’t always mean better technology. Today, there are antibiotics created decades ago that are more efficient than the new, cheaper, and sometimes more harmful ones. 

Mental health also falls victim to the problems of medicalization. There are many children diagnosed with attention deficit and hyperactivity disorder who, in reality, don’t meet the criteria. As a result, these children undergo a series of measures that are taken against them that are totally counterproductive.

It’s not something that will change overnight, but it’s a path we must take. Quaternary prevention can make us safer as patients and make medical resources available to all, without depleting them.

All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

  • Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoulle M. Prevención cuaternaria, actividad del médico general. [Quartäre Prävention, eine Aufgabe für Hausärzte]. Primary Care. 2010;10:350-4.
  • Gérvas, Juan. “Moderación en la actividad médica preventiva y curativa. Cuatro ejemplos de necesidad de prevención cuaternaria en España.” Gaceta sanitaria 20 (2006): 127-134.
  • Kopitowski, Karin Silvana. “Prevención cuaternaria: se pueden y se deben limitar los daños por la actividad sanitaria.” Rev. Hosp. Ital. B. Aires 33.3 (2013): 90-95.

This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.