Abstract
According to the World Organization of Family Doctors (WONCA), quaternary prevention (P4) is a recent concept that aims to prevent medical overuse. Thus, this study aimed to measure and map research output on P4 as outline research trends, evaluating its current international status through a bibliometric and descriptive content analysis. We reviewed scientific articles on P4 recorded in PubMed, LILACS, SciELO or CINAHL with the outcomes: publication year, first authors' name and nationality, journals' name, country and ranking, publication language, used methods and main reported subjects. The analysis included 65 articles published in 33 journals of 16 countries between 2003 and 2018 with a peak of publications in 2015. The first authors came from 17 different countries, 23% Brazilian, with Uruguay as the leading nation in scientific production per capita. Q1 or Q2 journals amassed 28% of published papers. Bibliographic research comprised 88% of articles and 38% of all focused on specific examples of medical overuse. P4 represents an ethical and valid approach to prevent iatrogenic events and achieve equal and fair access to health services. Conceptual, geographical, and linguistic elements, as well as WONCA conferences and type of healthcare systems in the authors' country were fundamental factors that affected research output. The available studies are still of limited quality and quantity, with further investigations needed to assess the effective impact of P4 on public health.
Highlights
The concept of medicalization is frequently misused to define the excessive use of medical care, but in an etymological perspective, it represents the process where some phenomena of human life become a medical concern
This paper aimed to report a bibliometric and descriptive content analysis on the concept of quaternary prevention (P4) in research published until August of 2018, and to prospectively correlate research trends
We used two complementary methods to achieve an integral assessment of research output on P4: a quantitative bibliometric approach – focused on measuring and evaluating research trends 12,13 – and a qualitative content analysis
Summary
The concept of medicalization is frequently misused to define the excessive use of medical care, but in an etymological perspective, it represents the process where some phenomena of human life become a medical concern. Jamoulle’s classification comprised two specific dimensions, one defined by the patient’s feeling (illness) and the other by the clinical assessment (disease) 5: (i) Primary prevention (P1) acts on healthy individuals (absence of illness) to prevent a specific disease (absence of disease), by advising smoking cessation to prevent lung cancer and chronic obstructive pulmonary disease (COPD), for example. (ii) Secondary prevention (P2) aims to early detect a potentially severe disease in an asymptomatic population (absence of illness), increasing cure probability by identifying and treating its initial stage (presence of disease), such as an annual eye fundoscopy to detect diabetic retinopathy. (iv) Quaternary prevention (P4) aims to prevent medical overuse in situations where the patient feels ill (illness present), but the physician does not attribute the symptoms to any biological disease (absence of disease). An example is the use the watchful wainting strategy when a young healthy patient with no cardiovascular risk or symptom worries about his cholesterol level
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