Parte III. Recursos asistenciales y utilización
Moderación en la actividad médica preventiva y curativa. Cuatro ejemplos de necesidad de prevención cuaternaria en España
Diagnostic and therapeutic activity moderation. Quaternary and genetic prevention
Juan Gérvas
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jgervasc@meditex.es
Correspondencia: Juan Gérvas. Equipo CESCA. Travesía de la Playa, 3. 28730 Buitrago del Lozoya. Madrid. España.
Correspondencia: Juan Gérvas. Equipo CESCA. Travesía de la Playa, 3. 28730 Buitrago del Lozoya. Madrid. España.
Equipo CESCA. Madrid. España
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Recursos asistenciales y utilización</span>" "titulo" => "Moderación en la actividad médica preventiva y curativa. Cuatro ejemplos de necesidad de prevención cuaternaria en España" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "127" "paginaFinal" => "134" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Gérvas" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Juan" "apellidos" => "Gérvas" "email" => array:1 [ 0 => "jgervasc@meditex.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Equipo CESCA. Madrid. España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Juan Gérvas. Equipo CESCA. Travesía de la Playa, 3. 28730 Buitrago del Lozoya. Madrid. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Diagnostic and therapeutic activity moderation. Quaternary and genetic prevention" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec13948" "palabras" => array:3 [ 0 => "Seguridad del paciente" 1 => "Prevención cuaternaria" 2 => "España" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec13947" "palabras" => array:3 [ 0 => "Patient security" 1 => "Quaternary prevention" 2 => "Spain" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">La actividad clínica tiene más ventajas que inconvenientes, lo que justifica su realización, y su aprecio social. Sin embargo, con el curso de los años y el desarrollo tecnológico, están disminuyendo el umbral para la intervención médica, y el margen entre beneficios y riesgos. Cada vez se atiende a más pacientes con mayor intensidad de recursos preventivos y curatives (de diagnóstico y de tratamiento), y en lugares inapropiados (donde se concentran esos recursos). Todo ello aumenta la probabilidad del daño innecesario por consecuencia de la actividad sanitaria. Es decir, disminuye lo que llamamos «seguridad del paciente».</p><p class="elsevierStyleSimplePara elsevierViewall">No basta con ofrecer servicios de calidad a quienes los necesitan, pues hay que conseguir, también, ofrecer cantidad en el lugar oportuno. Así, la actividad médica debería ofrecer cuidados de «baja intensidad y gran calidad», con una actitud activa continua que evite los daños por esas actividades, necesarias o innecesarias (prevención cuaternaria).</p><p class="elsevierStyleSimplePara elsevierViewall">En este trabajo se consideran cuatro ejemplos de la necesidad de aplicar prevención cuaternaria en España: <span class="elsevierStyleItalic">1)</span> la prevención cardiovascular (donde se hace de más a quienes no lo necesitan, y de menos a los que lo precisan), <span class="elsevierStyleItalic">2)</span> el uso de los nuevos antidepresivos (que ha provocado una «epidemia» de depresiones, de incierto diagnóstico), <span class="elsevierStyleItalic">3)</span> el uso de antibióticos (muchas veces innecesario, con el consiguiente aumento no justificado de las resistencias bacterianas), y <span class="elsevierStyleItalic">4)</span> el diagnóstico genético (con el ejemplo de la promoción del cribado de la hemocromatosis, de dudoso valor científico, pero indudable efecto en la medicalización de la sociedad).</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Medical activities have more positive than negative outcomes. Because this balance, medicine has a great social recognition. But with new technology and more agressive 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.</p><p class="elsevierStyleSimplePara elsevierViewall">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 continous parallel clinical activity.</p><p class="elsevierStyleSimplePara elsevierViewall">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 antidepresants (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).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:61 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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Información del artículo
ISSN: 02139111Idioma original: Español
DOI:10.1157/13086036
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