title: Activating GENeral practitioners dialogue with patients on their Agenda (MultiCare AGENDA) study protocol for a cluster randomized controlled trial.
abstract: BACKGROUND
  This study investigates the efficacy of a complex multifaceted intervention aiming at increasing the quality of care of GPs for patients with multimorbidity. In its core, the intervention aims at enhancing the doctor-patient-dialogue and identifying the patient's agenda and needs. Also, a medication check is embedded. Our primary hypothesis is that a more patient-centred communication will reduce the number of active pharmaceuticals taken without impairing the patients' quality of life. Secondary hypotheses include a better knowledge of GPs about their patients' medication, a higher patient satisfaction and a more effective and/or efficient health care utilization.
  
  
  METHODS
  Multi-center, parallel group, cluster randomized controlled clinical trial in GP surgeries.
  
  
  METHODS
  Patients aged 65-84 years with at least 3 chronic conditions.
  
  
  METHODS
  GPs allocated to this group will receive a multifaceted educational intervention on performing a narrative doctor-patient dialogue reflecting treatment targets and priorities of the patient and on performing a narrative patient-centred medication review. During the one year intervention GPs will have a total of three conversations à 30 minutes with the enrolled patients.
  
  
  METHODS
  Care as usual. Follow-up per patient: 14 months after baseline interview. Primary efficacy endpoints: Differences in medication intake and health related quality of life between baseline and follow-up in the intervention compared to the control group. Randomization: Computer-generated by an independent institute. It will be performed successively when patient recruitment in the respective surgery is finished. Blinding: Participants (GPs and patients) will not be blinded to their assignment but will be unaware of the study hypotheses or outcome measures.
  
  
  CONCLUSIONS
  There is growing evidence that the phenomenon of polypharmacy and low quality of drug use is substantially due to mis-communication (or non-communication) in the doctor patient interaction. We assume that the number of pharmaceutical agents taken can be reduced by a communicational intervention and that this will not impair the patients' health-related quality of life. Improving communication is a core issue of future interventions, especially for patients with multimorbidity.
  
  
  BACKGROUND
  Current CONTROLled Trials ISRCTN46272088.
authors.affiliation: Institute of General Practice, Medical Faculty, University of Rostock, Doberaner Str. 142, Rostock 18057, Germany.
authors.forename: Attila
authors.initials: A
authors.lastname: Altiner
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schäfer
authors.forename: Christine
authors.initials: C
authors.lastname: Mellert
authors.forename: Christin
authors.initials: C
authors.lastname: Löffler
authors.forename: Achim
authors.initials: A
authors.lastname: Mortsiefer
authors.forename: Annette
authors.initials: A
authors.lastname: Ernst
authors.forename: Carl-Otto
authors.initials: CO
authors.lastname: Stolzenbach
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.forename: Hanna
authors.initials: H
authors.lastname: Kaduszkiewicz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D003142:Communication; D015897:Comorbidity; D005500:Follow-Up Studies; D058006:General Practice / Q000379:methods* / Q000592:standards; D005858:Germany; D006801:Humans; D059065:Medication Reconciliation; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D010358:Patient Participation / Q000379:methods*; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D019338:Polypharmacy