title: The German MultiCare-study: Patterns of multimorbidity in primary health care - protocol of a prospective cohort study.
abstract: BACKGROUND
  Multimorbidity is a highly frequent condition in older people, but well designed longitudinal studies on the impact of multimorbidity on patients and the health care system have been remarkably scarce in numbers until today. Little is known about the long term impact of multimorbidity on the patients' life expectancy, functional status and quality of life as well as health care utilization over time. As a consequence, there is little help for GPs in adjusting care for these patients, even though studies suggest that adhering to present clinical practice guidelines in the care of patients with multimorbidity may have adverse effects.
  
  
  METHODS
  The study is designed as a multicentre prospective, observational cohort study of 3.050 patients aged 65 to 85 at baseline with at least three different diagnoses out of a list of 29 illnesses and syndromes. The patients will be recruited in approx. 120 to 150 GP surgeries in 8 study centres distributed across Germany. Information about the patients' morbidity will be collected mainly in GP interviews and from chart reviews. Functional status, resources/risk factors, health care utilization and additional morbidity data will be assessed in patient interviews, in which a multitude of well established standardized questionnaires and tests will be performed.
  
  
  CONCLUSIONS
  The main aim of the cohort study is to monitor the course of the illness process and to analyse for which reasons medical conditions are stable, deteriorating or only temporarily present. First, clusters of combinations of diseases/disorders (multimorbidity patterns) with a comparable impact (e.g. on quality of life and/or functional status) will be identified. Then the development of these clusters over time will be analysed, especially with regard to prognostic variables and the somatic, psychological and social consequences as well as the utilization of health care resources. The results will allow the development of an instrument for prediction of the deterioration of the illness process and point at possibilities of prevention. The practical consequences of the study results for primary care will be analysed in expert focus groups in order to develop strategies for the inclusion of the aspects of multimorbidity in primary care guidelines.
authors: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. in.schaefer@uke.uni-hamburg.de
authors: Ingmar
authors: I
authors: Schäfer
authors: Heike
authors: H
authors: Hansen
authors: Gerhard
authors: G
authors: Schön
authors: Wolfgang
authors: W
authors: Maier
authors: Susanne
authors: S
authors: Höfels
authors: Attila
authors: A
authors: Altiner
authors: Angela
authors: A
authors: Fuchs
authors: Ferdinand M
authors: FM
authors: Gerlach
authors: Juliana J
authors: JJ
authors: Petersen
authors: Jochen
authors: J
authors: Gensichen
authors: Sven
authors: S
authors: Schulz
authors: Steffi
authors: S
authors: Riedel-Heller
authors: Melanie
authors: M
authors: Luppa
authors: Siegfried
authors: S
authors: Weyerer
authors: Jochen
authors: J
authors: Werle
authors: Horst
authors: H
authors: Bickel
authors: Kerstin
authors: K
authors: Barth
authors: Hans-Helmut
authors: HH
authors: König
authors: Anja
authors: A
authors: Rudolph
authors: Birgitt
authors: B
authors: Wiese
authors: Jana
authors: J
authors: Prokein
authors: Monika
authors: M
authors: Bullinger
authors: Olaf
authors: O
authors: von dem Knesebeck
authors: Marion
authors: M
authors: Eisele
authors: Hanna
authors: H
authors: Kaduszkiewicz
authors: Karl
authors: K
authors: Wegscheider
authors: Hendrik
authors: H
authors: van den Bussche
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity / Q000639:trends*; D005260:Female; D005858:Germany; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies