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Quaternary prevention and mental health

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Academic year: 2021

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Marc Jamoulle, Family doctor, Charleroi , Belgium University of Liège, Belgium. Department of general practice

University of Rouen, France. Dep of Information and Informatics

Quaternary prevention of mental

health problems in primary care

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Mental health is the secret

garden of family medicine

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Self Care

Psychotic patient before heroin

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Musée d’art Contemporain St Etienne Are strange patients sick patients?

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The consultation

A relation between

two human beings

With different knowledge

With different agenda

Both uncertain and unsecure

1/1 1/n

Jamoulle M, Vander Stichele RH, Cardillo E, Roumier J, Grosjean J, Darmoni S..

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Bae J, Jamoulle M. Primary Care Physicians ’ Action Plans for Answering to Results of Screening Test based on the Concept of Quaternary Prevention. Journal of Preventive Medicine and Public Health = Yebang Uihakhoe Chi . 2016;1–16. Available from:

http://hdl.handle.net/2268/202673

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Differential aspects of prevention levels between Leavell and Clark versus Jamoulle and Roland.

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Stacey Diagram Patient agreement versus doctor uncertainty P4 could prevent anarchy

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Why? Why so many Drugs? Answering To chaos With Drugs

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• Systems of classification form a juncture of social organization,

moral order, and layers of technical integration

• Classification systems reflect the conflicting, contradictory

motives of the sociotechnical situation that gave rise to them

Geoffrey C Bowker i. Sorting thinks out. MIT Press 1999. p33

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« Mental health problems » in 500 emergency unit records (randomized on 1,815,588) (coding SNOMED CT)

Liljeqvist HTG, Muscatello D, Sara G, Dinh M, Lawrence GL. Accuracy of automatic syndromic classification of coded emergency department diagnoses in identifying mental health-related presentations for public health surveillance. BMC medical informatics and decision making. 2014;14:84. doi:10.1186/1472-6947-14-84.

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CIAP-2 ICPC-2 CISP-2

Patients (green) / Doctors (Cyan) Back to GP/FM

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Group of French doctor. Continuous Profesional Development

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in six steps. (previous distribution of texts)

Step1; one month before the seminar : retrieving of clinical

personal experiences

Step 2; sharing experiences in little groups report synthesis.,

critical reading exercises to do

Step 3; (second day) Critical reading report experts

contributions.

Step4; Disease or disease mongering in mental health case

reports debate.

Step 5; Pros & cons trial about ADD/H, tribunal, attorney,

lawyer, jury and final judgment.

Step 6; After one month,

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• Identification of the demand of the patient?

• Who is asking ; the patient, a third person ?

• What is the final expected outcome?

• Does the patient share it?

• Shared decision making? Informed consent?

• Which resource, family ? network ? social support?

• Is it urgent, which kind of ?

• Which therapy? No drug therapy possible?

• If any, deep knowledge of some chosen drugs

• Therapeutic education of the patient, of the family?

• Which knowledge has the patient about the problem?

• Who rule the treatment if any?

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But the general conclusions of the seminar

were that quaternary prevention is not a

technique but an attitude, an active thought

about the facts and about the doctor himself

in action

Lattanzio Nicoli

Angeli musicanti 1640 Rietti, museum , Italy Vincenzo manenti

Virgine St Ana (detail) 1634 Rietti Museum, Italy

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Thank you

Trainees at Espace-temps, Maison de Santé, Gilly , Belgium, 2015

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