Dissertation research about multimorbidity in Brazil

Researcher Januse Nogueira de Carvalho

The interest for multimorbidity has increased over the last years in Brazil. The high frequency of multiple health problems in the same individual added to the shortage of detailed scientific information about the problem, instigating researchers and health professionals to understand the standard of multimorbidity in the country. The researcher Januse Nogueira de Carvalho found relevant data on the topic in a dissertation defended in 2017 in the PhD Program in Collective Health of the Federal University of Rio Grande do Norte (UFRN). In an interview, she tells us a little bit more about her study.


1) What are the reasons that led you to conduct a dissertation research on multimorbidity?

For the construction of the dissertation, I tried to work with a relevent topic still little explored by the scientific literature, especially in our country. The Quaternary prevention theme was in evidence in the discussions of the 4th Ibero American Congress of Family and Community Medicine in Montevideo, Uruguay, in 2015, and aroused my interest. Quaternary prevention is a set of actions aimed to prevent damage associated with medical interventions and other health professionals, such as excessive medication or unnecessary surgeries (iatrogenic). I discussed my interest in the subject with my advisor and came to work with the theme of multimorbidity because it is a condition totally related to such damages.

2) Were there any difficulties in drawing up the project? If so, which ones?
There were methodological difficulties to ensure a minimum subjective bias of the researcher. For this, in the statistical analysis we consider that the data were derived from a complex sample. The project was based on the data of the National Health Research 2013, under public domain.

3) What results did you consider the most relevant?

The most relevant data were: 1) The high prevalence of two or more chronic diseases between persons aged 18 years or older (1 to 4 individuals), reaching half of the elderly (60 years or older); 2) The considerable prevalence of multimorbidity in the economically active population; 3) Obesity and the current and past smoking habits associated with a higher prevalence of multimorbidity. These factors suggest that the way of living in today’s society has determined a food pattern that, coupled with sedentariness, is generally unfavorable to the health of the population. The fact that there is a representativeness of the economically active workforce, for example, suggests that the primary health care services are not organized so as to meet this share of the population properly.

4) What is the practical application of these results?
The results show us the direction that should be taken to deal with the populations affected by multimorbidity. There is a need, for example, of stimulating physical activity practices to handle with obesity, as well as the realization of food consumption assessment and anthropometry of individuals in all phases of life by health services. It is also necessary to include actions to prevent work-related diseases.

5) In your opinion, what are the challenges for the advancement of the field of multimorbidity?
Among the main challenges, we point out to the awakening of professionals, especially those involved with primary attention, and the need for an approach based on the principle of comprehensiveness. In order to see individuals from the perspective of multimorbidity, multiprofessional teams should consider the migration of the welfare model with emphasis on curative procedures to a comprehensive model with emphasis on actions towards health promotion and prevention. Another point would be the elaboration of multimorbidity approach protocols to reduce the possibility of overlapping therapeutic indications and multiple consultations with professionals from different backgrounds.


6) For this to happen, what changes need to be implemented?

The crux of the matter goes through the training and profile of  thehealth professionals, especially doctors. The pedagogical model, with the division of curricular disciplines in departments with emphasis on specialties and the job market favorable to superspecialists are points that probably contribute to the performance of these professionals. In the care of patients one should consider the interaction between diseases in order to minimize iatrogenesis, in addition to minimizing costs with recurrent hospitalizations and other complications arising from multimorbidity.


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