Multimorbidity and Quaternary Prevention (P4)

Dee Mangin; Iona Heath

doi:10.5712/rbmfc10(35)1069

Authors

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,

DOI:

https://doi.org/10.5712/rbmfc10(35)1069

Keywords:

Health of the Elderly, Comorbidity, Drug Interactions, Medicalization, Quaternary Prevention

Abstract

Multimorbidity has become the norm for the majority of patients attending primary care, and while the proportion of those with multimorbidity is higher in older age, the absolute number of people with multimorbidity is greater in those under 65. The specialist-based single-disease model of treatment assumes that each index disease is the dominant illness within the complex system and that the other comorbid illnesses are held constant while management is focussed on the single condition. Thus, applying single disease guidelines to a person with five chronic comorbidities, no matter what they are, results in potentially harmful polypharmacy. This approach has led to the current ‘epidemic’ in morbidity and mortality from adverse drug reactions that now outstrip the target diseases as a cause of death. In this article, we highlight four characteristics of quaternary prevention framework that policymakers should take into account when considering the quality of health care.

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Author Biographies

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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