Multimorbidade e Prevenção Quaternária (P4)


  • Dee Mangin David Braley Nancy Gordon Chair in Family Medicine, Department of Family Medicine, McMaster University. Hamilton, Ontario,
  • Iona Heath Retired general practitioner, Immediate Past President of the Royal College of General Practitioners,



Saúde do Idoso, Comorbidade, Interações de Medicamentos, Medicalização, Prevenção Quaternária


A multimorbidade se tornou a norma para a maioria dos pacientes atendidos nos serviços de atenção primária à saúde, e enquanto a proporção de pessoas com multimorbidade é maior em idades mais avançadas, o número absoluto de pessoas com multimorbidade é maior em pessoas com menos
de 65 anos. O modelo de tratamento de doença única, com base no especialista focal, pressupõe que cada doença-índice seja a doença dominante dentro de um sistema complexo e que as outras comorbidades se mantenham constantes, enquanto o seu manejo é centrado em uma única condição. Assim, aplicando-se as diretrizes de doenças-únicas para uma pessoa com cinco comorbidades crônicas, não importando quais sejam elas, resulta em uma polifarmácia, potencialmente nociva. Esta abordagem tem conduzido a atual “epidemia” da morbidade e mortalidade por reações adversas a medicamentos, que já ultrapassa as doenças-alvo como causas de morte. Neste artigo, destacam-se quatro características da prevenção quaternária, que gestores de saúde deveriam levar em conta ao considerarem a qualidade dos cuidados em saúde


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Biografia do Autor

Dee Mangin, David Braley Nancy Gordon Chair in Family Medicine, Department of Family Medicine, McMaster University. Hamilton, Ontario,

Dee Mangin moved to Canada from New Zealand in late 2013. Prior to moving to Canada she was the Director of the Primary Care Unit at the University of Otago, Christchurch as well as  a Clinical Advisory Board member and Clincal Leader for Research Audit and Evaluation at the Pegasus Health Primary Healthcare Organisation.  She was a Ministerially appointed member of the Pharmaceutical and Therapeutic Products Advisory Committee to PHARMAC and served on the Southern Region Ethics Committee. She is a Fellow of the Royal New Zealand College of General Practitioners and in  2011 received their Distinguished Service Medal.

Her broad interests are rational prescribing, innovative models of primary care delivery, and the influences of science, policy and commerce on the nature of care. She has expertise in the effects on prescribing of pharmaceutical company promotion to consumers and physicians. She has wide clinical research experience in primary care using observational quantitative research methods including cohort studies, cross sectional studies and case control studies. She has specific experience in interventional studies:  in community RCTs of innovative models of care, and of clinical interventions including antidepressant use, community acquired pneumonia, antibiotics in urinary tract infection, and in “deprescribing” trials of the reduction of multiple medicines in older adults in older age, and effective incorporation of evidence into patient centred practice.

Iona Heath, Retired general practitioner, Immediate Past President of the Royal College of General Practitioners,

Dr. Iona Heath worked as an inner city general practitioner at the Caversham Group Practice in Kentish Town in London from 1975 until 2010. She was a nationally elected member of the Council of the Royal College of General Practitioners 1989 to 2009 and chaired the College’s Committee on Medical Ethics from 1998 to 2004 and the International Committee from 2006 to 2009. She has been a member of the Wonca World Executive since 1997. In November 2009, she was elected as President of the Royal College of General Practitioners for a three year term. She has written regularly for the British Medical Journal in her personal capacity. Her book ‘Matters of Life and Death’ was published in 2007.


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Como Citar

Mangin D, Heath I. Multimorbidade e Prevenção Quaternária (P4). Rev Bras Med Fam Comunidade [Internet]. 24º de junho de 2015 [citado 20º de fevereiro de 2024];10(35):1-5. Disponível em: