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

Abstract

BackgroundMultimorbidity 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/DesignThe 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.DiscussionThe 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.

Multimorbidity in primary care: a systematic review of prospective cohort studies

“…Three protocol papers [14][15][16] were excluded, leaving six papers, which related to five separate cohort studies (Figure 1). [17][18][19][20][21][22] Nature and scope of studies Study aims.…”

Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

“…The study design and recruitment procedures have already been published in detail [22]. In brief, patients were randomly selected and recruited from 158 general practices in eight German cities.…”

A comparative study demonstrated that prevalence figures on multimorbidity require cautious interpretation when drawn from a single database

“…The design of the study, process of elaboration of the disease list, procedure for the recruitment of the patients, and process of data collection have been described in the study protocol [12] and a recent cohort description article [14]. The recruitment and baseline data collection for MC-Cohort took place from July 2008 to October 2009.…”

“…2. Methods of case identification [8]: for example, standardized clinical examinations [9], chart review, patient self-reports [10], claims data analysis [11], parallel interviews with physicians and patients [12], or clinical registers [13]. 3.…”