Table 2 Quaternary prevention from a primary care perspective
Quaternary prevention strategies: Levels of influence | ||
|---|---|---|
A. DIRECT | B. INTERMEDIATE | C. INDIRECT |
A1. Establishing a trustful doctor-patient-relationship | B1. Promotion of a primary care-centred health care model | C1. Improving health care structures |
Focus on a long-term relationship between doctor and patient | Improvement of evidence-based primary care | Restriction of non-evidence-based individual health services (direct payment) |
Shared-decision-making | GP as guide and coordinator | Population-based health care approach (instead of an extended high risk approach) |
Improving soft skills (communication, empathy) | Distinction between primary and secondary care | Change in reimbursement paradigms: less incentives for technical diagnostics |
Holistic patient assessment (including the patient’s social background) | Better integration of primary care into medical school curriculum | |
A2. Reducing diagnostic uncertainty | B2. Patient education | C2. Discussion in society as a whole |
High quality, evidence-based medical education and training | Information on evidence for recommended or requested services | Identification of relevant stakeholders |
Supervision for young GPs | Information on advantages of a wait-and-see-approach instead of immediate maximum diagnostics | Process of setting priorities in health care |
Stepwise diagnostics: Focus on anamnesis and physical examination | Information on importance of health-conscious behaviour/personal responsibility | |
Well-founded “wait and see” | Price/cost transparency | |