dördüncül koruma ve aşırı medikalizasyon

Yıl 2023, Cilt: 17 Sayı: 4 - Turkish Journal of Family Medicine and Primary Care, 572 - 581, 19.12.2023

Uğur Büyükokudan , Kadriye Avcı

https://doi.org/10.21763/tjfmpc.1329929

Öz

Dördüncül koruma, aşırı tıbbi medikalizasyon riski altındaki kişilerin belirlenmesi ve hastaların gereksiz tıbbi müdahalelere karşı korunmalarını içerir. Günümüzde gelişen teknoloji ve artan sağlık hizmeti kullanımıyla beraber, hastalara gereksiz aşırı teşhis ve aşırı tedavi uygulanabilmektedir. Aşırı medikalizasyon kavramı ise, hastalara sağladığı faydalar açısından doğrulanmamış, potansiyel olarak zararlı ve bu nedenle gereksiz maliyetlere yol açan tıbbi uygulamalar olarak tanımlanmaktadır. Bunlar hastalarda sosyal, psikolojik ve ekonomik yönden olumsuz etkilenme; sağlık sisteminde ise memnuniyetsizlik ve ekonomik yükü arttırmaktadır. İnsanların tüm yaşamları boyunca tıbbi müdahalelerden zarar görebileceği düşünüldüğünde, dördüncül koruma ve aşırı medikalizasyon kavramı bu bağlamda büyük önem taşımaktadır. Aşırı medikalizasyonu azaltmak ve dördüncül korumayı sağlamak için; hastaların karar verme sürecine katılımı ve ortak karar alma, güvenilir hasta-hekim ilişkisi kurulması, birinci basamak sağlık hizmetlerinin teşvik edilmesi ve sevk sisteminin düzenlenmesi önem taşımaktadır.

Anahtar Kelimeler

medikalizasyon, koruyucu sağlık hizmetleri, koruyucu hekimlik

quaternary prevention and over-medicalization

Öz

Quaternary prevention involves identifying patients who are at risk of over-medicalization and protecting patients from unnecessary medical intervention. In fact, patients are currently at risk of unnecessary over-diagnosis and over-treatment as technology progresses and the use of health-care services grows. Over-medicalization is described as medical treatments that have not been validated in terms of patient benefits, are potentially detrimental, and so incur unnecessary expenses. These have a negative social, psychological, and economic impact on patients, while also increasing dissatisfaction and the financial burden on the health-care system. Given the potential for long-term harm from medical interventions, the concept of quaternary prevention and over-medicalization is significant in this particular setting. Patients' engagement in decision-making and shared decision-making, building a trustworthy patient-physician relationship, expanding primary health care services, and regulating the referral system are all crucial to minimizing over-medicalization and providing quaternary prevention.

Anahtar Kelimeler

medicalization, Preventive Health Services, Preventive medicine

Kaynakça

• 1. Basan NM, Bilir N. Koruyucu sağlık hizmetlerinde önleme çelişkisi ve nedenleri. TAF Preventive Medicine Bulletin. 2016;15(1)
• 2. Kisling LA, Das JM. Prevention strategies. StatPearls [internet]. StatPearls Publishing; 2021. p1-3.
• 3. Akdeniz M, Kavukçu E. Dördüncül koruma: Önce zarar verme. Turkish Journal of Family Practice/Türkiye Aile Hekimligi Dergisi. 2017;21(2)
• 4. World Health Organization. Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity. URL: http://www emro who int/aboutwho/public-health-functions/health-promotion-disease-prevention html[Stand: 0209 2017]. Accessed March 28,2023.
• 5. Martins C, Godycki-Cwirko M, Heleno B, Brodersen J. Quaternary prevention: reviewing the concept. European Journal of General Practice. 2018/01/01 2018;24(1):106-111. doi:10.1080/13814788.2017.1422177
• 6. Jamoulle M. The four duties of family doctors. Quaternary prevention: first, do no harm. Hong Kong Practitioner. 2014;36: 1-6.
• 7. Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoulle M. Quaternary prevention: a task of the general practitioner. Primary Care. 2010;10:350–354.
• 8. Jamoulle M, Roland M. Quaternary prevention. Paper presented at the Hong-Kong Meeting of the Wonca Classification Commitee; June, 1995. Accessed March-April 2023.
• 9. Depallens MA, Guimarães JMdM, Almeida Filho N. Quaternary prevention: a concept relevant to public health? A bibliometric and descriptive content analysis. Cadernos de Saúde Pública. 2020; 36(7):e00231819
• 10. Jamoulle M. Quaternary prevention: first, do not harm. Revista Brasileira de Medicina de Família e Comunidade. 2015;10(35):1-3.
• 11. Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. International Journal of Health Policy and Management. 2015;4(2):61.
• 12. Norman AH, Tesser CD. Quaternary prevention: a balanced approach to demedicalisation. The British Journal of General Practice. 2019;69(678):28.
• 13. Pandve HT. Quaternary prevention: need of the hour. J Family Med Prim Care. 2014;3(4):309-10.
• 14. Widmer D, Herzig L, Jamoulle M. Quaternary prevention: is acting always justified in family medicine? Revue Medicale Suisse. 2014;10(430):1052-1056.
• 15. Brodersen J, Schwartz LM, Woloshin S. Overdiagnosis: how cancer screening can turn indolent pathology into illness. Apmis. Aug 2014;122(8):683-9. doi:10.1111/apm.12278
• 16. Martins C, Godycki-Cwirko M, Heleno B, Brodersen J. Quaternary prevention: an evidence-based concept aiming to protect patients from medical harm. Br J Gen Pract. Dec 2019;69(689):614-615. doi:10.3399/bjgp19X706913
• 17. Conrad P. Medicalization and social control. Annual review of Sociology. 1992:209-232.
• 18. Bardakçı T. Tıbbın yaşamlarımızdaki hakimiyeti: medikalizasyon. Anatolian Clinic the Journal of Medical Sciences. 2022;27(3):347-356.
• 19. Toraman A, Erdem R. Kavramsal Açıdan Tıbbileştirme. Hacettepe Sağlık İdaresi Dergisi. 2016;19(4):423-442.
• 20. Carter SM, Rogers W, Heath I, Degeling C, Doust J, Barratt A. The challenge of overdiagnosis begins with its definition. Bmj. 2015;350: h869.
• 21. Carter SM, Degeling C, Doust J, Barratt A. A definition and ethical evaluation of overdiagnosis. Journal of medical ethics. 2016;42(11):705-714.
• 22. Bhatt JR, Klotz L. Overtreatment in cancer–is it a problem? : Taylor & Francis; 2016. p. 1-5.
• 23. Hofmann B. Medicalization and overdiagnosis: different but alike. Medicine, Health Care and Philosophy. 2016/06/01 2016;19(2):253-264. doi:10.1007/s11019-016-9693-6
• 24. Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D. 2019 update on medical overuse: a review. JAMA internal medicine. 2019;179(11):1568-1574. 25. Rolfe A, Burton C. Reassurance after diagnostic testing with a low pretest probability of serious disease: systematic review and meta-analysis. JAMA Intern Med. Mar 25 2013;173(6):407-16. doi:10.1001/jamainternmed.2013.2762
• 26. Esserman LJ, Thompson IM, Jr, Reid B. Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement. JAMA. 2013;310(8):797-798. doi:10.1001/jama.2013.108415
• 27. Garcia-Alamino JM, López-Cano M. Overdiagnosis and overtreatment - More is better? Cir Esp (Engl Ed). Dec 2022;100(12):793-794. doi:10.1016/j.cireng.2022.06.053
• 28. Hofmann B. Back to basics: overdiagnosis is about unwarranted diagnosis. American Journal of Epidemiology. 2019;188(10):1812-1817.
• 29. Alber K, Kuehlein T, Schedlbauer A, Schaffer S. Medical overuse and quaternary prevention in primary care – A qualitative study with general practitioners. BMC Family Practice. 2017/12/08 2017;18(1):99. doi:10.1186/s12875-017-0667-4
• 30. Sood R, Sood A, Ghosh AK. Non-evidence-based variables affecting physicians’ test-ordering tendencies: a systematic review. Neth J Med. 2007;65(5):167-177.
• 31. Kale MS, Korenstein D. Overdiagnosis in primary care: framing the problem and finding solutions. Bmj. 2018;362
• 32. Whiting P, Toerien M, de Salis I, et al. A review identifies and classifies reasons for ordering diagnostic tests. Journal of clinical epidemiology. 2007;60(10):981-989.
• 33. Borkan J, Reis S, Hermoni D, Biderman A. Talking about the pain: a patient-centered study of low back pain in primary care. Social science & medicine. 1995;40(7):977-988.
• 34. Ooi K. The pitfalls of overtreatment: Why more care is not necessarily beneficial. Asian Bioethics Review. 2020;12(4):399-417.
• 35. Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. Bmj. 2012;344:e3502.
• 36. Santos Cruz R, Brito-Costa S, Santa Rosa B, Silvestre M. Overtreatment in elderly care: ethical considerations. Acta Biomed. May 11 2022;93(2):e2022136. doi:10.23750/abm.v93i2.12855
• 37. Björkhem-Bergman L. Overtreatment in end-of-life care: how can we do better? Acta Oncol. Dec 2022;61(12):1435-1436. doi:10.1080/0284186x.2023.2164919
• 38. Starfield B, Hyde J, Gérvas J, Heath I. The concept of prevention: a good idea gone astray? Journal of Epidemiology & Community Health. 2008;62(7):580-583.
• 39. Bulliard J-L, Chiolero A. Screening and overdiagnosis: public health implications. Public Health Reviews. 2015/11/05 2015;36(1):8. doi:10.1186/s40985-015-0012-1
• 40. Van den Bruel A, Jones C, Yang Y, Oke J, Hewitson P. People’s willingness to accept overdetection in cancer screening: population survey. Bmj. 2015;350:h980
• 41. Katz MH, Grady D, Redberg RF. Undertreatment Improves, but Overtreatment Does Not. JAMA Internal Medicine. 2013;173(2):93-93. doi:10.1001/jamainternmed.2013.2361
• 42. Lyu H, Xu T, Brotman D, et al. Overtreatment in the united states. PloS one. 2017;12(9):e0181970.
• 43. Singh H, Dickinson JA, Thériault G, et al. Overdiagnosis: causes and consequences in primary health care. Canadian Family Physician. 2018;64(9):654-659.
• 44. King MT, Winters ZE, Olivotto IA, et al. Patient-reported outcomes in ductal carcinoma in situ: a systematic review. European Journal of Cancer. 2017;71:95-108.
• 45. Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. The Lancet. 2017/07/08/ 2017;390(10090):156-168. doi:https://doi.org/10.1016/S0140-6736(16)32585-5
• 46. Korenstein D, Chimonas S, Barrow B, Keyhani S, Troy A, Lipitz-Snyderman A. Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments. JAMA Intern Med. Oct 1 2018;178(10):1401-1407. doi:10.1001/jamainternmed.2018.3573
• 47. Cushner F, Agnelli G, FitzGerald G, Warwick D. Complications and functional outcomes after total hip arthroplasty and total knee arthroplasty: results from the Global Orthopaedic Registry (GLORY). 2010;
• 48. Bandovas JP, Leal B, Reis-de-Carvalho C, et al. Broadening risk factor or disease definition as a driver for overdiagnosis: A narrative review. Journal of Internal Medicine. 2022;291(4):426-437. doi:https://doi.org/10.1111/joim.13465
• 49. Heath I. Overdiagnosis: when good intentions meet vested interests—an essay by Iona Heath. Bmj. 2013;347
• 50. Berwick DM. Avoiding overuse—the next quality frontier. The Lancet. 2017;390(10090):102-104.
• 51. Si Y, Bateman H, Chen S, et al. Quantifying the financial impact of overuse in primary care in China: A standardised patient study. Social Science & Medicine. 2023/03/01/ 2023;320:115670. doi:https://doi.org/10.1016/j.socscimed.2023.115670
• 52. Black WC. Overdiagnosis: an underrecognized cause of confusion and harm in cancer screening. Journal of the National Cancer Institute. 2000;92(16):1280-1282.
• 53. Hakama M, Pokhrel A, Malila N, Hakulinen T. Sensitivity, effect and overdiagnosis in screening for cancers with detectable pre-invasive phase. International Journal of Cancer. 2015;136(4):928-935. doi:https://doi.org/10.1002/ijc.29053
• 54. Chandrashekar P, Fendrick AM, Ganguli I. Stopping the Flood: Reducing Harmful Cascades of Care. American Journal of Managed Care. 2021; 27: 178–180.
• 55. Visentin G. The difficult choice of" not doing": comment on" Quaternary prevention, an answer of family doctors to overmedicalization". International journal of health policy and management. 2015;4(8):559.
• 56. Rudin RS, Thakore N, Mulligan KL, Ganguli I. Addressing the Drivers of Medical Test Overuse and Cascades: User-Centered Design to Improve Patient–Doctor Communication. The Joint Commission Journal on Quality and Patient Safety. 2022/04/01/ 2022;48(4):233-240. doi:https://doi.org/10.1016/j.jcjq.2022.01.005
• 57. Morgan DJ, Brownlee S, Leppin AL, et al. Setting a research agenda for medical overuse. Bmj. 2015;35: h4534.
• 58. Moynihan RN, Cooke GP, Doust JA, Bero L, Hill S, Glasziou PP. Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States. PLoS Med. Aug 2013;10(8):e1001500. doi:10.1371/journal.pmed.1001500
• 59. Levinson W, Born K, Wolfson D. Choosing wisely campaigns: a work in progress. Jama. 2018;319(19):1975-1976.
• 60. Yardımcı B. İç Hastalıklarında Akılcı Seçimler. Klinik Tıp Bilimleri. 2018;6(2):40-54.
• 61. Venkatesh AK, Hajdasz D, Rothenberg C, et al. Reducing unnecessary blood chemistry testing in the emergency department: implementation of choosing wisely. American Journal of Medical Quality. 2018;33(1):81-85.