The German MultiCare-study: Patterns of multimorbidity in primary health care - protocol of a prospective cohort study

被引：56

作者：

Schaefer, Ingmar ^{[2
]}

Hansen, Heike ^{[2
]}

Schoen, Gerhard ^{[3
]}

Maier, Wolfgang ^{[4
]}

Hoefels, Susanne ^{[4
]}

Altiner, Attila ^{[5
]}

Fuchs, Angela ^{[5
]}

Gerlach, Ferdinand M. ^{[6
]}

Petersen, Juliana J. ^{[6
]}

Gensichen, Jochen ^{[7
]}

Schulz, Sven ^{[7
]}

Riedel-Heller, Steffi ^{[8
,14
]}

Luppa, Melanie ^{[11
]}

Weyerer, Siegfried ^{[9
]}

Werle, Jochen ^{[9
]}

Bickel, Horst ^{[10
]}

Barth, Kerstin ^{[10
]}

Koenig, Hans-Helmut ^{[11
]}

Rudolph, Anja ^{[11
]}

Wiese, Birgitt ^{[1
]}

Prokein, Jana ^{[1
]}

Bullinger, Monika ^{[12
]}

von dem Knesebeck, Olaf ^{[13
]}

Eisele, Marion ^{[2
]}

Kaduszkiewicz, Hanna ^{[2
]}

Wegscheider, Karl ^{[3
]}

van den Bussche, Hendrik ^{[2
]}

机构：

[1] Hannover Med Sch, Inst Biometry, D-30623 Hannover, Germany

[2] Univ Med Ctr Hamburg Eppendorf, Dept Primary Med Care, D-20246 Hamburg, Germany

[3] Univ Med Ctr Hamburg Eppendorf, Dept Med Biometry & Epidemiol, D-20246 Hamburg, Germany

[4] Univ Bonn, Dept Psychiat & Psychotherapy, D-53105 Bonn, Germany

[5] Univ Dusseldorf, Dept Gen Practice, D-40225 Dusseldorf, Germany

[6] Goethe Univ Frankfurt, Inst Gen Practice, D-60590 Frankfurt, Germany

[7] Univ Jena, Inst Gen Practice, D-07743 Jena, Germany

[8] Univ Leipzig, Dept Psychiat, Publ Hlth Res Unit, D-04103 Leipzig, Germany

[9] Cent Inst Mental Hlth, D-68159 Mannheim, Germany

[10] Tech Univ Munich, Dept Psychiat, D-81675 Munich, Germany

[11] Univ Leipzig, Dept Psychiat, Hlth Econ Res Unit, D-04103 Leipzig, Germany

[12] Univ Med Ctr Hamburg Eppendorf, Dept Med Psychol, D-20246 Hamburg, Germany

[13] Univ Med Ctr Hamburg Eppendorf, Dept Med Sociol, D-20246 Hamburg, Germany

[14] Univ Leipzig, Dept Social Med, D-04103 Leipzig, Germany

来源：

BMC HEALTH SERVICES RESEARCH | 2009年 / 9卷

关键词：

GENERAL-PRACTICE; QUESTIONNAIRE; COMORBIDITY; DEMENTIA; DISEASES; DEPRESSION; VERSION; AGE;

D O I：

10.1186/1472-6963-9-145

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

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/Design: 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. Discussion: 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.

引用

页数：9

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