The German MultiCare-study: Patterns of multimorbidity in primary health care – protocol of a prospective cohort study
Identifieur interne : 000F54 ( Main/Exploration ); précédent : 000F53; suivant : 000F55The German MultiCare-study: Patterns of multimorbidity in primary health care – protocol of a prospective cohort study
Auteurs : Ingmar Sch Fer [Allemagne] ; Heike Hansen [Allemagne] ; Gerhard Schön [Allemagne] ; Wolfgang Maier [Allemagne] ; Susanne Höfels [Allemagne] ; Attila Altiner [Allemagne] ; Angela Fuchs [Allemagne] ; Ferdinand M. Gerlach [Allemagne] ; Juliana J. Petersen [Allemagne] ; Jochen Gensichen [Allemagne] ; Sven Schulz [Allemagne] ; Steffi Riedel-Heller [Allemagne] ; Melanie Luppa [Allemagne] ; Siegfried Weyerer [Allemagne] ; Jochen Werle [Allemagne] ; Horst Bickel [Allemagne] ; Kerstin Barth [Allemagne] ; Hans-Helmut König [Allemagne] ; Anja Rudolph [Allemagne] ; Birgitt Wiese [Allemagne] ; Jana Prokein [Allemagne] ; Monika Bullinger [Allemagne] ; Olaf Von Dem Knesebeck [Allemagne] ; Marion Eisele [Allemagne] ; Hanna Kaduszkiewicz [Allemagne] ; Karl Wegscheider [Allemagne] ; Hendrik Van Den Bussche [Allemagne]Source :
- BMC Health Services Research [ 1472-6963 ] ; 2009.
Abstract
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.
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.
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.
Url:
DOI: 10.1186/1472-6963-9-145
PubMed: 19671164
PubMed Central: 3224741
Affiliations:
- Allemagne
- Bade-Wurtemberg, Basse-Saxe, Bavière, District de Cologne, District de Darmstadt, District de Düsseldorf, District de Haute-Bavière, District de Karlsruhe, District de Leipzig, Hambourg, Hesse (Land), Rhénanie-du-Nord-Westphalie, Saxe (Land)
- Bonn, Düsseldorf, Francfort-sur-le-Main, Hambourg, Hanovre, Leipzig, Mannheim, Munich
- Université Louis-et-Maximilien de Munich
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Le document en format XML
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(Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Rudolph, Anja" sort="Rudolph, Anja" uniqKey="Rudolph A" first="Anja" last="Rudolph">Anja Rudolph</name><affiliation wicri:level="3"><nlm:aff id="I10">Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Liebigstr. 26, 04103 Leipzig, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Liebigstr. 26, 04103 Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Wiese, Birgitt" sort="Wiese, Birgitt" uniqKey="Wiese B" first="Birgitt" last="Wiese">Birgitt Wiese</name><affiliation wicri:level="3"><nlm:aff id="I11">Institute for Biometry, Hannover Medical School, 30623 Hannover, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute for Biometry, Hannover Medical School, 30623 Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Prokein, Jana" sort="Prokein, Jana" uniqKey="Prokein J" first="Jana" last="Prokein">Jana Prokein</name><affiliation wicri:level="3"><nlm:aff id="I11">Institute for Biometry, Hannover Medical School, 30623 Hannover, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute for Biometry, Hannover Medical School, 30623 Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Bullinger, Monika" sort="Bullinger, Monika" uniqKey="Bullinger M" first="Monika" last="Bullinger">Monika Bullinger</name><affiliation wicri:level="1"><nlm:aff id="I12">Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Knesebeck, Olaf Von Dem" sort="Knesebeck, Olaf Von Dem" uniqKey="Knesebeck O" first="Olaf Von Dem" last="Knesebeck">Olaf Von Dem Knesebeck</name><affiliation wicri:level="1"><nlm:aff id="I13">Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Eisele, Marion" sort="Eisele, Marion" uniqKey="Eisele M" first="Marion" last="Eisele">Marion Eisele</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Kaduszkiewicz, Hanna" sort="Kaduszkiewicz, Hanna" uniqKey="Kaduszkiewicz H" first="Hanna" last="Kaduszkiewicz">Hanna Kaduszkiewicz</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Wegscheider, Karl" sort="Wegscheider, Karl" uniqKey="Wegscheider K" first="Karl" last="Wegscheider">Karl Wegscheider</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Medical Biometry and 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type="wicri:Area/Ncbi/Curation">000644</idno><idno type="wicri:Area/Ncbi/Checkpoint">000644</idno><idno type="wicri:Area/Main/Merge">000F57</idno><idno type="wicri:Area/Main/Curation">000F54</idno><idno type="wicri:Area/Main/Exploration">000F54</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The German MultiCare-study: Patterns of multimorbidity in primary health care – protocol of a prospective cohort study</title><author><name sortKey="Sch Fer, Ingmar" sort="Sch Fer, Ingmar" uniqKey="Sch Fer I" first="Ingmar" last="Sch Fer">Ingmar Sch Fer</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Hansen, Heike" sort="Hansen, Heike" uniqKey="Hansen H" first="Heike" last="Hansen">Heike Hansen</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Schon, Gerhard" sort="Schon, Gerhard" uniqKey="Schon G" first="Gerhard" last="Schön">Gerhard Schön</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Maier, Wolfgang" sort="Maier, Wolfgang" uniqKey="Maier W" first="Wolfgang" last="Maier">Wolfgang Maier</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn</wicri:regionArea><wicri:noRegion>53105 Bonn</wicri:noRegion><placeName><settlement type="city">Bonn</settlement><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Cologne</region></placeName></affiliation></author><author><name sortKey="Hofels, Susanne" sort="Hofels, Susanne" uniqKey="Hofels S" first="Susanne" last="Höfels">Susanne Höfels</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn</wicri:regionArea><wicri:noRegion>53105 Bonn</wicri:noRegion><placeName><settlement type="city">Bonn</settlement><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Cologne</region></placeName></affiliation></author><author><name sortKey="Altiner, Attila" sort="Altiner, Attila" uniqKey="Altiner A" first="Attila" last="Altiner">Attila Altiner</name><affiliation wicri:level="3"><nlm:aff id="I4">Department of General Practice, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of General Practice, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf</wicri:regionArea><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Düsseldorf</region><settlement type="city">Düsseldorf</settlement></placeName></affiliation></author><author><name sortKey="Fuchs, Angela" sort="Fuchs, Angela" uniqKey="Fuchs A" first="Angela" last="Fuchs">Angela Fuchs</name><affiliation wicri:level="3"><nlm:aff id="I4">Department of General Practice, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of General Practice, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf</wicri:regionArea><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Düsseldorf</region><settlement type="city">Düsseldorf</settlement></placeName></affiliation></author><author><name sortKey="Gerlach, Ferdinand M" sort="Gerlach, Ferdinand M" uniqKey="Gerlach F" first="Ferdinand M" last="Gerlach">Ferdinand M. Gerlach</name><affiliation wicri:level="3"><nlm:aff id="I5">Institute for General Practice, University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute for General Practice, University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Petersen, Juliana J" sort="Petersen, Juliana J" uniqKey="Petersen J" first="Juliana J" last="Petersen">Juliana J. Petersen</name><affiliation wicri:level="3"><nlm:aff id="I5">Institute for General Practice, University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute for General Practice, University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Gensichen, Jochen" sort="Gensichen, Jochen" uniqKey="Gensichen J" first="Jochen" last="Gensichen">Jochen Gensichen</name><affiliation wicri:level="1"><nlm:aff id="I6">Institute for General Practice, University of Jena, Bachstraße 18, 07743 Jena, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute for General Practice, University of Jena, Bachstraße 18, 07743 Jena</wicri:regionArea><wicri:noRegion>07743 Jena</wicri:noRegion><wicri:noRegion>07743 Jena</wicri:noRegion><wicri:noRegion>07743 Jena</wicri:noRegion></affiliation></author><author><name sortKey="Schulz, Sven" sort="Schulz, Sven" uniqKey="Schulz S" first="Sven" last="Schulz">Sven Schulz</name><affiliation wicri:level="1"><nlm:aff id="I6">Institute for General Practice, University of Jena, Bachstraße 18, 07743 Jena, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute for General Practice, University of Jena, Bachstraße 18, 07743 Jena</wicri:regionArea><wicri:noRegion>07743 Jena</wicri:noRegion><wicri:noRegion>07743 Jena</wicri:noRegion><wicri:noRegion>07743 Jena</wicri:noRegion></affiliation></author><author><name sortKey="Riedel Heller, Steffi" sort="Riedel Heller, Steffi" uniqKey="Riedel Heller S" first="Steffi" last="Riedel-Heller">Steffi Riedel-Heller</name><affiliation wicri:level="3"><nlm:aff id="I7">Public Health Research Unit, Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Public Health Research Unit, Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="I14">Department of Social Medicine, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Social Medicine, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Luppa, Melanie" sort="Luppa, Melanie" uniqKey="Luppa M" first="Melanie" last="Luppa">Melanie Luppa</name><affiliation wicri:level="3"><nlm:aff id="I10">Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Liebigstr. 26, 04103 Leipzig, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Liebigstr. 26, 04103 Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Weyerer, Siegfried" sort="Weyerer, Siegfried" uniqKey="Weyerer S" first="Siegfried" last="Weyerer">Siegfried Weyerer</name><affiliation wicri:level="3"><nlm:aff id="I8">Central Institute of Mental Health, J 5, 68159 Mannheim, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Central Institute of Mental Health, J 5, 68159 Mannheim</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Mannheim</settlement></placeName></affiliation></author><author><name sortKey="Werle, Jochen" sort="Werle, Jochen" uniqKey="Werle J" first="Jochen" last="Werle">Jochen Werle</name><affiliation wicri:level="3"><nlm:aff id="I8">Central Institute of Mental Health, J 5, 68159 Mannheim, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Central Institute of Mental Health, J 5, 68159 Mannheim</wicri:regionArea><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Mannheim</settlement></placeName></affiliation></author><author><name sortKey="Bickel, Horst" sort="Bickel, Horst" uniqKey="Bickel H" first="Horst" last="Bickel">Horst Bickel</name><affiliation wicri:level="4"><nlm:aff id="I9">Department of Psychiatry, Technical University of Munich, Ismaninger Str. 22, 81675 München, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Psychiatry, Technical University of Munich, Ismaninger Str. 22, 81675 München</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Barth, Kerstin" sort="Barth, Kerstin" uniqKey="Barth K" first="Kerstin" last="Barth">Kerstin Barth</name><affiliation wicri:level="4"><nlm:aff id="I9">Department of Psychiatry, Technical University of Munich, Ismaninger Str. 22, 81675 München, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Psychiatry, Technical University of Munich, Ismaninger Str. 22, 81675 München</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Konig, Hans Helmut" sort="Konig, Hans Helmut" uniqKey="Konig H" first="Hans-Helmut" last="König">Hans-Helmut König</name><affiliation wicri:level="3"><nlm:aff id="I10">Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Liebigstr. 26, 04103 Leipzig, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Liebigstr. 26, 04103 Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Rudolph, Anja" sort="Rudolph, Anja" uniqKey="Rudolph A" first="Anja" last="Rudolph">Anja Rudolph</name><affiliation wicri:level="3"><nlm:aff id="I10">Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Liebigstr. 26, 04103 Leipzig, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Liebigstr. 26, 04103 Leipzig</wicri:regionArea><placeName><region type="land" nuts="1">Saxe (Land)</region><region type="district" nuts="2">District de Leipzig</region><settlement type="city">Leipzig</settlement></placeName></affiliation></author><author><name sortKey="Wiese, Birgitt" sort="Wiese, Birgitt" uniqKey="Wiese B" first="Birgitt" last="Wiese">Birgitt Wiese</name><affiliation wicri:level="3"><nlm:aff id="I11">Institute for Biometry, Hannover Medical School, 30623 Hannover, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute for Biometry, Hannover Medical School, 30623 Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Prokein, Jana" sort="Prokein, Jana" uniqKey="Prokein J" first="Jana" last="Prokein">Jana Prokein</name><affiliation wicri:level="3"><nlm:aff id="I11">Institute for Biometry, Hannover Medical School, 30623 Hannover, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Institute for Biometry, Hannover Medical School, 30623 Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Bullinger, Monika" sort="Bullinger, Monika" uniqKey="Bullinger M" first="Monika" last="Bullinger">Monika Bullinger</name><affiliation wicri:level="1"><nlm:aff id="I12">Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Knesebeck, Olaf Von Dem" sort="Knesebeck, Olaf Von Dem" uniqKey="Knesebeck O" first="Olaf Von Dem" last="Knesebeck">Olaf Von Dem Knesebeck</name><affiliation wicri:level="1"><nlm:aff id="I13">Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Eisele, Marion" sort="Eisele, Marion" uniqKey="Eisele M" first="Marion" last="Eisele">Marion Eisele</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Kaduszkiewicz, Hanna" sort="Kaduszkiewicz, Hanna" uniqKey="Kaduszkiewicz H" first="Hanna" last="Kaduszkiewicz">Hanna Kaduszkiewicz</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Wegscheider, Karl" sort="Wegscheider, Karl" uniqKey="Wegscheider K" first="Karl" last="Wegscheider">Karl Wegscheider</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author><author><name sortKey="Bussche, Hendrik Van Den" sort="Bussche, Hendrik Van Den" uniqKey="Bussche H" first="Hendrik Van Den" last="Bussche">Hendrik Van Den Bussche</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg</wicri:regionArea><wicri:noRegion>20246 Hamburg</wicri:noRegion><placeName><settlement type="city">Hambourg</settlement><region type="land" nuts="2">Hambourg</region></placeName></affiliation></author></analytic><series><title level="j">BMC Health Services Research</title><idno type="eISSN">1472-6963</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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.</p></sec><sec><title>Methods/Design</title><p>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.</p></sec><sec><title>Discussion</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Akker, M Van Den" uniqKey="Akker M">M Van den Akker</name></author><author><name sortKey="Buntinx, F" uniqKey="Buntinx F">F Buntinx</name></author><author><name sortKey="Roos, S" uniqKey="Roos S">S Roos</name></author><author><name sortKey="Knottnerus, Ja" uniqKey="Knottnerus J">JA Knottnerus</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marengoni, A" uniqKey="Marengoni A">A Marengoni</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fortin, M" uniqKey="Fortin M">M Fortin</name></author><author><name sortKey="Lapointe, L" uniqKey="Lapointe L">L Lapointe</name></author><author><name 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Heinrich</name></author><author><name sortKey="Luppa, M" uniqKey="Luppa M">M Luppa</name></author><author><name sortKey="Matschinger, H" uniqKey="Matschinger H">H Matschinger</name></author><author><name sortKey="Angermeyer, Mc" uniqKey="Angermeyer M">MC Angermeyer</name></author><author><name sortKey="Riedel Heller, Sg" uniqKey="Riedel Heller S">SG Riedel-Heller</name></author><author><name sortKey="Konig, Hh" uniqKey="Konig H">HH König</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gensichen, J" uniqKey="Gensichen J">J Gensichen</name></author><author><name sortKey="Muth, C" uniqKey="Muth C">C Muth</name></author><author><name sortKey="Butzlaff, M" uniqKey="Butzlaff M">M Butzlaff</name></author><author><name sortKey="Rosemann, T" uniqKey="Rosemann T">T Rosemann</name></author><author><name sortKey="Raspe, H" uniqKey="Raspe H">H Raspe</name></author><author><name sortKey="Muller De Cornejo, G" uniqKey="Muller De Cornejo G">G Müller de 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uniqKey="Wade D">DT Wade</name></author><author><name sortKey="Davies, S" uniqKey="Davies S">S Davies</name></author><author><name sortKey="Horne, V" uniqKey="Horne V">V Horne</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lawton, Mp" uniqKey="Lawton M">MP Lawton</name></author><author><name sortKey="Brody, Em" uniqKey="Brody E">EM Brody</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bos, K" uniqKey="Bos K">K Bös</name></author><author><name sortKey="Abel, T" uniqKey="Abel T">T Abel</name></author><author><name sortKey="Woll, A" uniqKey="Woll A">A Woll</name></author><author><name sortKey="Niemann, S" uniqKey="Niemann S">S Niemann</name></author><author><name sortKey="Tittlbach, S" uniqKey="Tittlbach S">S Tittlbach</name></author><author><name sortKey="Schott, N" uniqKey="Schott N">N Schott</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Welsh, K" uniqKey="Welsh K">K 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sortKey="Sallis, Jf" uniqKey="Sallis J">JF Sallis</name></author><author><name sortKey="Oja, P" uniqKey="Oja P">P Oja</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bush, K" uniqKey="Bush K">K Bush</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hinz, A" uniqKey="Hinz A">A Hinz</name></author><author><name sortKey="Schumacher, J" uniqKey="Schumacher J">J Schumacher</name></author><author><name sortKey="Albani, C" uniqKey="Albani C">C Albani</name></author><author><name sortKey="Schmid, G" uniqKey="Schmid G">G Schmid</name></author><author><name sortKey="Br Hler, E" uniqKey="Br Hler E">E Brähler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fydrich, T" uniqKey="Fydrich T">T Fydrich</name></author><author><name sortKey="Sommer, G" uniqKey="Sommer G">G Sommer</name></author><author><name sortKey="Br Hler, E" uniqKey="Br Hler E">E Brähler</name></author><author><name sortKey="F 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Petersen</name><name sortKey="Prokein, Jana" sort="Prokein, Jana" uniqKey="Prokein J" first="Jana" last="Prokein">Jana Prokein</name><name sortKey="Riedel Heller, Steffi" sort="Riedel Heller, Steffi" uniqKey="Riedel Heller S" first="Steffi" last="Riedel-Heller">Steffi Riedel-Heller</name><name sortKey="Riedel Heller, Steffi" sort="Riedel Heller, Steffi" uniqKey="Riedel Heller S" first="Steffi" last="Riedel-Heller">Steffi Riedel-Heller</name><name sortKey="Rudolph, Anja" sort="Rudolph, Anja" uniqKey="Rudolph A" first="Anja" last="Rudolph">Anja Rudolph</name><name sortKey="Schon, Gerhard" sort="Schon, Gerhard" uniqKey="Schon G" first="Gerhard" last="Schön">Gerhard Schön</name><name sortKey="Schulz, Sven" sort="Schulz, Sven" uniqKey="Schulz S" first="Sven" last="Schulz">Sven Schulz</name><name sortKey="Wegscheider, Karl" sort="Wegscheider, Karl" uniqKey="Wegscheider K" first="Karl" last="Wegscheider">Karl Wegscheider</name><name sortKey="Werle, Jochen" sort="Werle, Jochen" uniqKey="Werle J" first="Jochen" last="Werle">Jochen Werle</name><name sortKey="Weyerer, Siegfried" sort="Weyerer, Siegfried" uniqKey="Weyerer S" first="Siegfried" last="Weyerer">Siegfried Weyerer</name><name sortKey="Wiese, Birgitt" sort="Wiese, Birgitt" uniqKey="Wiese B" first="Birgitt" last="Wiese">Birgitt Wiese</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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