Quaternary prevention and integrative and complementary practices (II): contextual approach

• Autor(a) principal: Tesser, Charles Dalcanale
• Data de Publicação: 2021
• Outros Autores: Norman, Armando Henrique
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Revista Brasileira de Medicina de Família e Comunidade (Online)
• Texto Completo: https://www.rbmfc.org.br/rbmfc/article/view/2566
• topic: Quaternary Prevention; Complementary Therapies; Primary Health Care; Family Practice; Program for Incentives and Benefits.; Prevención Cuaternaria; Terapias Complementarias; Atención Primaria de Salud; Medicina Familiar y Comunitaria; Programa de Estímulos e Incentivos.; Prevenção Quaternária; Terapias Complementares; Atenção Primária à saúde; Medicina de Família e Comunidade; Programa de Estímulos e Incentivos.

Introduction: Quaternary prevention (P4) may involve the use of integrative, complementary and alternative medicine (I&CAM), which have been progressively offered in primary health care (PHC). Objective: To discuss contextual aspects of PHC care that facilitate I&CAM as a P4 practice. Methods: Hermeneutic perspective essay, which involves the understanding of selected literature (‘reconstruction’) and a dialogue with the current practices of P4 (‘integration’) to broaden its horizons. Results and discussion: Several factors hinder the use of I&CAM as P4 in PHC. One of them is the evocation of evidence-based medicine (EBM) as an evaluator of the effectiveness of I&CAM. However, five sets of contextual arguments facilitate the use of I&CAM in PHC: (1) Critical approach by EBM to P4 and I&CAM; (2) Understanding I&CAM colonisation by biomedicine; (3) Contextual security derived from the longitudinality of care in PHC; (4) Patients’ clinical severity spectrum in PHC and effectiveness; and (5) The limitations inherent to EBM associated with health professionals’ knowledge on I&CAM and other medical rationalities can enrich and contribute to P4 practice. For this, I&CAM - especially in vitalistic medical rationalities - should be contextualised and aligned with patients’ values and preferences. Conclusion: A range of I&CAM and scientific evidence compose several sources of knowledge in PHC that can contribute to P4 in clinical decision-making. The I&CAM as P4 strategy is possible, justified, and should be stimulated in view of the complexity of care in the context of PHC, especially in spectrum of low to medium clinical severity.