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The quaternary prevention, concept coined by the Belgian general practitioner Marc Jamoulle,^[1] are the actions taken to identify a patient at risk of overmedicalisation, to protect them from new medical invasion, and to suggest interventions which are ethically acceptable.^[2]^[3]

Quaternary prevention is the set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the health system.^[4]

Social credit that legitimizes medical intervention may be damaged if doctors do not prevent unnecessary medical activity and its consequences. Quaternary prevention should take precedence over any alternative preventive, diagnostic and therapeutic, as dictated by the principle of primum non nocere.^[5]

Concept

			absent	present
Prevention levels ^[5]			Doctor’s side
			Disease
Patient’s side	Illness	absent	Primary prevention (illness absent disease absent)	Secondary prevention (illness absent disease present)
Patient’s side	Illness	present	Quaternary prevention (illness present disease absent)	Tertiary prevention (illness present disease present)

Main idea: to avoid patient overdiagnosis and overtreatment.

Use: During all the episode of care (preclinical and clinical period).

It's the "actions taken to identify patients at risk of overtreatment, to protect them from new medical procedures and ethically acceptable alternative to suggest". The concept is included in WONCA's Dictionary of General and Family Medicine. ^[6]

To do quaternary prevention is to say “no” to many considerably indecent proposals, and to offer prudent and scientific alternatives (“ethics of negation”, “ethics of ignorance sharing”). To do quaternary prevention is to exchange the fear exploited by healthcare malice for the feeling of knowing that what matters is the quality of life.^[7]

The intent of quaternary prevention is not to eliminate but rather to moderate the medicalization of the daily life, since a part of the aforementioned medicalization is not directly related to the medical intervention and has to do with social, cultural and psychologic reasons. Quaternary prevention is only about avoiding or palliating the medical part of the medicalization of the daily life.

To do quaternary prevention in clinical encounters is to comply with the scientific goal of Medicine, which aims for “the maximum quality with the minimum quantity, as close to the patient as possible”.

“To prevent is better than healing, when preventing is less harmful than healing”. To engage into quaternary prevention is to avoid the unnecessary curative and preventive activities. Every doctor-patient encounter should include quaternary prevention in order to avoid/limit the damage caused by the activity of the health system. To do it is to enforce the old motto primum non nocere.^[8]

Means

1.- Narrative based Medicine

The strongest means to accomplish this is to listen better to our patients. This is what has been termed Narrative based Medicine, which means to adapt the medically possible to the individual needs and wants. What we need is a strong and sustainable relationship with our patients and their trust in our honesty and specific knowledge.^[9]

2.- Evidence-based medicine

The other important means is called Evidence based Medicine. The knowledge of the probable predictive values of diagnostic tests and the probabilities of effect sizes of benefit and harm of therapy and preventive measures give us the opportunity to leave out many useless procedures.

Intervention types

Healthcare professionals must be aware of the consequences of their decisions, and include quaternary prevention interventions in their daily clinical practice with each patient.^[10]

To prevent the cascade effect:

- To prevent the diagnostic cascade

- To prevent the therapeutical cascade

To prevent disease promotion
To prevent medicalization

Activities

Do not mistake risk factor with disease.^[11]^[12]
To avoid check ups or unnecessary exams.,^[13]^[14]
To avoid technical interventionism in healthcare.
To avoid schooliosis.
To avoid the pharmacological treatment of hypercholesterolemia in primary prevention.^[15]
To avoid hormone replacement therapy during menopause
To avoid the indiscriminate use of antibiotics (very often unnecessary, with the subsequent unjustified increase of bacterial resistances)
To avoid unnecessary diagnosis of genetic disorders (for example: the promotion of the haemochromatosis screening, of doubtful scientific value, but of undoubted effect in terms of the medicalization of society.^[16]
To avoid the overdiagnosis and overtreatment of the attention deficit hyperactivity disorder (ADHD).^[17]
To elaborate validated diagnostic and therapeutic protocols that are effective in the prevention of the renal injury in the minority of patients with “complicated” pyelectasis, and that avoid the excessive amount of intervention in the majority of the patients with “simple” pyelectasis.^[18]

References

External links

[1] Jamoulle M. Information et informatisation en médecine générale. In: Berleur J, Labet-Maris Cl, Poswick RF, Valenduc G, Van Bastelaer Ph. Les informa-g-iciens. Namur (Belgique): Presses Universitaires de Namur; 1986. p.193-209.^{[permanent dead link]}

[2] Jamoulle M. About prevention; the Quaternary prevention. UCL. 2008

[3] Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. International Journal of Health Policy and Management. 4-Feb-2015; 4:1–4.

[4] Gervás J. La prevención cuaternaria. OMC. 2004;(95):8. Template:Wayback

[Kuehlein-5] Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoule M. Quaternary prevention: a task of the general practitioner. PrimaryCare. 2010; 10(18): 350-4.

[6] Bentzen N, editor. WONCA Dictionary of general/family practice. Copenhagen: Maanedskift Lager; 2003. Template:Wayback

[7] Gérvas J. Malicia sanitaria y prevención cuaternaria. Gac Med Bilbao. 2007; 104:93-6 Template:Wayback

[8] Gérvas J. Prevención cuaternaria. Acta Sanitaria. 2011/01/10.

[9] Greenhalgh T, Hurwitz B (ed.). Narrative based Medicine – Dialogue and Discourse in Clinical Practice. London: BMJ Books; 1998.

[10] Gérvas J. ¿El trabajo diario? ¡Basado en la prevención cuaternaria!. Boletín REAP. 2007; 4(1):6-7. Template:Wayback

[11] Gérvas J. Pérez Fernández M. Uso y abuso del poder médico para definir enfermedad y factor de riesgo, en relación con la prevención cuaternaria. Gac Sanit. 2006; 20(Supl 3):66-71. Template:Wayback

[12] Miguel F. Factores de riesgo: una nada inocente ambigüedad en el corazón de la medicina actual. Aten Primaria. 1998; 22:585-95.

[13] Gérvas J. Chequeos. Acta Sanitaria. 2010/09/06.

[14] Segura Benedicto A. Cribado de enfermedades y factores de riesgo en personas sanas. El lado oscuro de la fuerza. Humanitas. 2008 sept; (31):1-17. Template:Wayback

[15] Gérvas J. Moderación en la actividad médica preventiva y curativa. Cuatro ejemplos de necesidad de prevención cuaternaria en España. Gac Sanit. 2006; 20(Supl 1):127-34. Template:Wayback

[16] Gérvas J, Pérez Fernández M. Genética y prevención cuaternaria. El ejemplo de la hemocromatosis. Aten Primaria. 2003; 32:158-62. Template:Wayback

[17] Morell Sixto ME, Martínez González C, Quintana Gómez JL. Disease mongering, el lucrativo negocio de la promoción de enfermedades. Rev Pediatr Aten Primaria. 2009; 11(43):491-512.

[18] González de Dios J, Ochoa Sangrador C. Ectasia piélica perinatal, efecto cascada y prevención cuaternaria. An Pediatr (Barc). 2005; 63(1):83-5. Template:Wayback

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@@ Line 1: / Line 1: @@
 {{tone|date=October 2015}}
-The '''quaternary prevention''', concept coined by the Belgian [[general practitioner]] [http://www.ulb.ac.be/esp/mfsp/prev4-fr.html Marc Jamoulle],<ref>[http://docpatient.net/mj/IIMG_1986.pdf Jamoulle M. Information et informatisation en médecine générale. In: Berleur J, Labet-Maris Cl, Poswick RF, Valenduc G, Van Bastelaer Ph. Les informa-g-iciens. Namur (Belgique): Presses Universitaires de Namur; 1986. p.193-209.]</ref> are the actions taken to identify a [[patient]] at risk of [[medicalisation|overmedicalisation]], to protect them from new medical invasion, and to suggest  interventions which are ethically acceptable.<ref>[http://docpatient.net/mj/P4_citations.htm Jamoulle M. About prevention; the Quaternary prevention. UCL. 2008]</ref><ref>[http://orbi.ulg.ac.be/bitstream/2268/177984/1/IJHPM29501422995400.pdf  Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. International Journal of Health Policy and Management. 4-Feb-2015; 4:1–4.]</ref>
+The '''quaternary prevention''', concept coined by the Belgian [[general practitioner]] [http://www.ulb.ac.be/esp/mfsp/prev4-fr.html Marc Jamoulle],<ref>[http://docpatient.net/mj/IIMG_1986.pdf Jamoulle M. Information et informatisation en médecine générale. In: Berleur J, Labet-Maris Cl, Poswick RF, Valenduc G, Van Bastelaer Ph. Les informa-g-iciens. Namur (Belgique): Presses Universitaires de Namur; 1986. p.193-209.]{{dead link|date=July 2016 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> are the actions taken to identify a [[patient]] at risk of [[medicalisation|overmedicalisation]], to protect them from new medical invasion, and to suggest  interventions which are ethically acceptable.<ref>[http://docpatient.net/mj/P4_citations.htm Jamoulle M. About prevention; the Quaternary prevention. UCL. 2008]</ref><ref>[http://orbi.ulg.ac.be/bitstream/2268/177984/1/IJHPM29501422995400.pdf  Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. International Journal of Health Policy and Management. 4-Feb-2015; 4:1–4.]</ref>
-Quaternary prevention is the set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the [[health system]].<ref>[http://www.equipocesca.org/wp-content/uploads/2011/02/2004-06-la-prevencion-cuaternaria.pdf Gervás J. La prevención cuaternaria. OMC. 2004;(95):8.]</ref>
+Quaternary prevention is the set of health activities to mitigate or avoid the consequences of unnecessary or excessive intervention of the [[health system]].<ref>[http://www.equipocesca.org/wp-content/uploads/2011/02/2004-06-la-prevencion-cuaternaria.pdf Gervás J. La prevención cuaternaria. OMC. 2004;(95):8.] {{wayback|url=http://www.equipocesca.org/wp-content/uploads/2011/02/2004-06-la-prevencion-cuaternaria.pdf |date=20110726033754 }}</ref>
 Social credit that legitimizes medical intervention may be damaged if doctors do not prevent unnecessary medical activity and its consequences. Quaternary prevention should take precedence over any alternative preventive, diagnostic and therapeutic, as dictated by the principle of ''[[primum non nocere]]''.<ref name="Kuehlein">[http://www.primary-care.ch/docs/primarycare/archiv/de/2010/2010-18/2010-18-368_ELPS_engl.pdf  Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoule M. Quaternary prevention: a task of the general practitioner. PrimaryCare. 2010; 10(18): 350-4.]</ref>
@@ Line 32: / Line 32: @@
 It's the "actions taken to identify patients at risk of [[overtreatment]], to protect them from new medical procedures and ethically acceptable alternative to suggest". The concept is included in [[World Organization of Family Doctors|WONCA]]'s ''Dictionary of General and Family Medicine''.
-<ref>[http://www.globalfamilydoctor.com/wicc/dictionary2.html Bentzen N, editor. WONCA Dictionary of general/family practice. Copenhagen: Maanedskift Lager; 2003.]</ref>
+<ref>[http://www.globalfamilydoctor.com/wicc/dictionary2.html Bentzen N, editor. WONCA Dictionary of general/family practice. Copenhagen: Maanedskift Lager; 2003.] {{wayback|url=http://www.globalfamilydoctor.com/wicc/dictionary2.html |date=20110711101850 }}</ref>
-To do quaternary prevention is to say “no” to many considerably indecent proposals, and to offer prudent and scientific alternatives (“ethics of negation”, “ethics of ignorance sharing”). To do quaternary prevention is to exchange the fear exploited by healthcare malice for the feeling of knowing that what matters is the quality of life.<ref>[http://www.gacetamedicabilbao.org/web/pdfdownload.php?doi=070037jg Gérvas J. Malicia sanitaria y prevención cuaternaria. Gac Med Bilbao. 2007; 104:93-6]</ref>
+To do quaternary prevention is to say “no” to many considerably indecent proposals, and to offer prudent and scientific alternatives (“ethics of negation”, “ethics of ignorance sharing”). To do quaternary prevention is to exchange the fear exploited by healthcare malice for the feeling of knowing that what matters is the quality of life.<ref>[http://www.gacetamedicabilbao.org/web/pdfdownload.php?doi=070037jg Gérvas J. Malicia sanitaria y prevención cuaternaria. Gac Med Bilbao. 2007; 104:93-6] {{wayback|url=http://www.gacetamedicabilbao.org/web/pdfdownload.php?doi=070037jg |date=20160304000127 }}</ref>
 The intent of quaternary prevention is not to eliminate but rather to moderate the  medicalization of the daily life, since a part of the aforementioned medicalization is not directly related to the medical intervention and has to do with social, cultural and psychologic reasons. Quaternary prevention is only about avoiding or palliating the medical part of the medicalization of the daily life.
@@ Line 52: / Line 52: @@
 == Intervention types ==
-Healthcare professionals must be aware of the consequences of their decisions, and include quaternary prevention interventions in their daily clinical practice with each patient.<ref>[http://www.equipocesca.org/wp-content/uploads/2009/04/el-trabajo-diario-c2a1basado-en-la-prevencion-cuaternaria.pdf Gérvas J. ¿El trabajo diario? ¡Basado en la prevención cuaternaria!. Boletín REAP. 2007; 4(1):6-7.]</ref>
+Healthcare professionals must be aware of the consequences of their decisions, and include quaternary prevention interventions in their daily clinical practice with each patient.<ref>[http://www.equipocesca.org/wp-content/uploads/2009/04/el-trabajo-diario-c2a1basado-en-la-prevencion-cuaternaria.pdf Gérvas J. ¿El trabajo diario? ¡Basado en la prevención cuaternaria!. Boletín REAP. 2007; 4(1):6-7.] {{wayback|url=http://www.equipocesca.org/wp-content/uploads/2009/04/el-trabajo-diario-c2a1basado-en-la-prevencion-cuaternaria.pdf |date=20120317164702 }}</ref>
 * To prevent the cascade effect:
@@ Line 61: / Line 61: @@
 == Activities ==
-* Do not mistake risk factor with disease.<ref>[http://www.equipocesca.org/wp-content/uploads/2009/01/uso-y-abuso-gaceta-2006.pdf Gérvas J. Pérez Fernández M. Uso y abuso del poder médico para definir enfermedad y factor de riesgo, en relación con la prevención cuaternaria. Gac Sanit. 2006; 20(Supl 3):66-71.]</ref><ref>Miguel F. Factores de riesgo: una nada inocente ambigüedad en el corazón de la medicina actual. Aten Primaria. 1998; 22:585-95.</ref>
+* Do not mistake risk factor with disease.<ref>[http://www.equipocesca.org/wp-content/uploads/2009/01/uso-y-abuso-gaceta-2006.pdf Gérvas J. Pérez Fernández M. Uso y abuso del poder médico para definir enfermedad y factor de riesgo, en relación con la prevención cuaternaria. Gac Sanit. 2006; 20(Supl 3):66-71.] {{wayback|url=http://www.equipocesca.org/wp-content/uploads/2009/01/uso-y-abuso-gaceta-2006.pdf |date=20110923182941 }}</ref><ref>Miguel F. Factores de riesgo: una nada inocente ambigüedad en el corazón de la medicina actual. Aten Primaria. 1998; 22:585-95.</ref>
-* To avoid check ups or  unnecessary exams.,<ref>[http://www.actasanitaria.com/actasanitaria/frontend/desarrollo_noticia.jsp?idCanal=23&idContenido=21082 Gérvas J. Chequeos. Acta Sanitaria. 2010/09/06.]</ref><ref>[http://www.fundacionmhm.org/www_humanitas_es_numero31/revista.html Segura Benedicto A. Cribado de enfermedades y factores de riesgo en personas sanas. El lado oscuro de la fuerza. Humanitas.  2008 sept; (31):1-17.]</ref>
+* To avoid check ups or  unnecessary exams.,<ref>[http://www.actasanitaria.com/actasanitaria/frontend/desarrollo_noticia.jsp?idCanal=23&idContenido=21082 Gérvas J. Chequeos. Acta Sanitaria. 2010/09/06.]</ref><ref>[http://www.fundacionmhm.org/www_humanitas_es_numero31/revista.html Segura Benedicto A. Cribado de enfermedades y factores de riesgo en personas sanas. El lado oscuro de la fuerza. Humanitas.  2008 sept; (31):1-17.] {{wayback|url=http://www.fundacionmhm.org/www_humanitas_es_numero31/revista.html |date=20120322191707 }}</ref>
 * To avoid technical interventionism in healthcare.
 * To avoid [[schooliosis]].
-* To avoid the pharmacological treatment of [[hypercholesterolemia]] in [[primary prevention]].<ref>[http://www.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13086036&pident_usuario=0&pcontactid=&pident_revista=138&ty=90&accion=S&origen=elsevier&web=www.elsevier.es&lan=es&fichero=138v20nSupl.1a13086036pdf001.pdf Gérvas J. Moderación en la actividad médica preventiva y curativa. Cuatro ejemplos de necesidad de prevención cuaternaria en España. Gac Sanit. 2006; 20(Supl 1):127-34.]</ref>
+* To avoid the pharmacological treatment of [[hypercholesterolemia]] in [[primary prevention]].<ref>[http://www.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13086036&pident_usuario=0&pcontactid=&pident_revista=138&ty=90&accion=S&origen=elsevier&web=www.elsevier.es&lan=es&fichero=138v20nSupl.1a13086036pdf001.pdf Gérvas J. Moderación en la actividad médica preventiva y curativa. Cuatro ejemplos de necesidad de prevención cuaternaria en España. Gac Sanit. 2006; 20(Supl 1):127-34.] {{wayback|url=http://www.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13086036&pident_usuario=0&pcontactid=&pident_revista=138&ty=90&accion=S&origen=elsevier&web=www.elsevier.es&lan=es&fichero=138v20nSupl.1a13086036pdf001.pdf |date=20100327073153 }}</ref>
 * To avoid [[hormone replacement therapy]] during menopause
 * To avoid the indiscriminate use of antibiotics (very often unnecessary, with the subsequent unjustified increase of bacterial resistances)
-* To avoid unnecessary diagnosis of genetic disorders (for example: the promotion of the [[haemochromatosis]] [[Screening (medicine)|screening]], of doubtful scientific value, but of undoubted effect in terms of the medicalization of society.<ref>[http://www.equipocesca.org/wp-content/uploads/2009/04/genetica-y-prevencion-cuaternaria-el-ejemplo-de-la-hemocromatosis.pdf Gérvas J, Pérez Fernández M. Genética y prevención cuaternaria. El ejemplo de la hemocromatosis. Aten Primaria. 2003; 32:158-62.]</ref>
+* To avoid unnecessary diagnosis of genetic disorders (for example: the promotion of the [[haemochromatosis]] [[Screening (medicine)|screening]], of doubtful scientific value, but of undoubted effect in terms of the medicalization of society.<ref>[http://www.equipocesca.org/wp-content/uploads/2009/04/genetica-y-prevencion-cuaternaria-el-ejemplo-de-la-hemocromatosis.pdf Gérvas J, Pérez Fernández M. Genética y prevención cuaternaria. El ejemplo de la hemocromatosis. Aten Primaria. 2003; 32:158-62.] {{wayback|url=http://www.equipocesca.org/wp-content/uploads/2009/04/genetica-y-prevencion-cuaternaria-el-ejemplo-de-la-hemocromatosis.pdf |date=20120317164747 }}</ref>
 * To avoid the [[overdiagnosis]] and [[overtreatment]] of the attention deficit hyperactivity disorder (ADHD).<ref>[http://www.pap.es/files/1116-930-pdf/1062.pdf Morell Sixto ME, Martínez González C, Quintana Gómez JL. Disease mongering, el lucrativo negocio de la promoción de enfermedades. Rev Pediatr Aten Primaria. 2009; 11(43):491-512.]</ref>
-* To elaborate validated [[diagnostic]] and [[therapeutic]] [[Medical guideline|protocols]] that are effective in the prevention of the renal injury in the minority of patients with “complicated” [[pyelectasis]], and that avoid the excessive amount of intervention in the majority of the patients with “simple” pyelectasis.<ref>[http://www.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13076777&pident_usuario=0&pcontactid=&pident_revista=37&ty=65&accion=S&origen=elsevier&web=www.elsevier.es&lan=es&fichero=37v63n01a13076777pdf001.pdf González de Dios J, Ochoa Sangrador C. Ectasia piélica perinatal, efecto cascada y prevención cuaternaria. An Pediatr (Barc). 2005; 63(1):83-5.]</ref>
+* To elaborate validated [[diagnostic]] and [[therapeutic]] [[Medical guideline|protocols]] that are effective in the prevention of the renal injury in the minority of patients with “complicated” [[pyelectasis]], and that avoid the excessive amount of intervention in the majority of the patients with “simple” pyelectasis.<ref>[http://www.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13076777&pident_usuario=0&pcontactid=&pident_revista=37&ty=65&accion=S&origen=elsevier&web=www.elsevier.es&lan=es&fichero=37v63n01a13076777pdf001.pdf González de Dios J, Ochoa Sangrador C. Ectasia piélica perinatal, efecto cascada y prevención cuaternaria. An Pediatr (Barc). 2005; 63(1):83-5.] {{wayback|url=http://www.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=13076777&pident_usuario=0&pcontactid=&pident_revista=37&ty=65&accion=S&origen=elsevier&web=www.elsevier.es&lan=es&fichero=37v63n01a13076777pdf001.pdf |date=20100327073153 }}</ref>
 == See also ==
@@ Line 94: / Line 94: @@
 * [http://www.ima.org.il/imaj/ar00jula-1a.pdf Gofrit ON, Shemer J, Leibovici D, Modan B, Shapira SC. Quaternary prevention: a new look at an old challenge. Isr Med Assoc J. 2000;2(7):498-500.]
 * [http://books.google.com/books?id=Yk5ORAzzYa0C&pg=PA223&dq=ortun&hl=es#v=onepage&q=&f=false  Ortún V. Gestión clínica y sanitaria. De la práctica diaria a la academia, ida y vuelta. Barcelona: Elsevier/Masson; 2003. p.245]
-* [http://www.uemo.org/members/official_documents/dwds08_2.htm UEMO, European Union of General Practitioners / Family Physicians, Santiago LM. Quaternary prevention. Document 2008/040, October 2008.]
+* [http://www.uemo.org/members/official_documents/dwds08_2.htm UEMO, European Union of General Practitioners / Family Physicians, Santiago LM. Quaternary prevention. Document 2008/040, October 2008.]{{dead link|date=July 2016 |bot=InternetArchiveBot |fix-attempted=yes }}
-* [http://www.equipocesca.org/wp-content/uploads/2009/03/prevention-lancet-final-2008.pdf Gérvas J, Starfield B, Heath I. Is clinical prevention better than cure? Lancet. 2008;372:1997-99.]
+* [http://web.archive.org/web/20120317164646/http://www.equipocesca.org/wp-content/uploads/2009/03/prevention-lancet-final-2008.pdf Gérvas J, Starfield B, Heath I. Is clinical prevention better than cure? Lancet. 2008;372:1997-99.]
 * [http://docpatient.net/mj/P4_brasilia_2011.pdf Marc Jamoulle. Paradigm shift in Primary Care working fields. 11th congress of SBMFC, Brazilia, June 2011.]
-* [http://www.prospective-jeunesse.be/IMG/pdf/DSP60-JAMOULLE.pdf  Marc Jamoulle. la prévention quaternaire, une tâche explicite du médecin généraliste. Prospective Jeunesse. 2012; 7–11.]
+* [http://www.prospective-jeunesse.be/IMG/pdf/DSP60-JAMOULLE.pdf  Marc Jamoulle. la prévention quaternaire, une tâche explicite du médecin généraliste. Prospective Jeunesse. 2012; 7–11.]{{dead link|date=July 2016 |bot=InternetArchiveBot |fix-attempted=yes }}
-* [http://www.camfic.cat/Docs/12_13/P4interviewnevejamoulle2012.pdf Julien Nève, Marc Jamoulle. Quaternary prevention, an explicit task of the physician. Oct 25, 2012.]
+* [http://www.camfic.cat/Docs/12_13/P4interviewnevejamoulle2012.pdf Julien Nève, Marc Jamoulle. Quaternary prevention, an explicit task of the physician. Oct 25, 2012.]{{dead link|date=July 2016 |bot=InternetArchiveBot |fix-attempted=yes }}
 * [http://equipocesca.org/new/wp-content/uploads/2012/12/QP-ancianos-Gervas-Rev-Esp-Geriatr-Gerontol-2012.pdf  Gérvas J. Prevención cuaternaria en ancianos. Rev Esp Geriatr Gerontol. 2012; 47(6):266-9.]
 * [http://www.rbmfc.org.br/rbmfc/index  Quaternary Prevention (P4). Revista Brasileira de Medicina de Família e Comunidade. 2015; 10(35).]