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

Ingmar Schäfer1, Heike Hansen1, Gerhard Schön2, Wolfgang Maier3, Susanne Höfels3, Attila Altiner4, Angela Fuchs4, Ferdinand M Gerlach5, Juliana J Petersen5, Jochen Gensichen6, Sven Schulz6, Steffi Riedel-Heller147, Melanie Luppa10, Siegfried Weyerer8, Jochen Werle8, Horst Bickel9, Kerstin Barth9, Hans-Helmut König10, Anja Rudolph10, Birgitt Wiese11*, Jana Prokein11, Monika Bullinger12, Olaf von dem Knesebeck13, Marion Eisele1, Hanna Kaduszkiewicz1, Karl Wegscheider2 and Hendrik van den Bussche1

Author Affiliations

1 Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

2 Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

3 Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105 Bonn, Germany

4 Department of General Practice, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany

5 Institute for General Practice, University of Frankfurt am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany

6 Institute for General Practice, University of Jena, Bachstraße 18, 07743 Jena, Germany

7 Public Health Research Unit, Department of Psychiatry, University of Leipzig, Semmelweisstr. 10, 04103 Leipzig, Germany

8 Central Institute of Mental Health, J 5, 68159 Mannheim, Germany

9 Department of Psychiatry, Technical University of Munich, Ismaninger Str. 22, 81675 München, Germany

10 Health Economics Research Unit, Department of Psychiatry, University of Leipzig, Liebigstr. 26, 04103 Leipzig, Germany

11 Institute for Biometry, Hannover Medical School, 30623 Hannover, Germany

12 Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

13 Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

14 Department of Social Medicine, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany

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BMC Health Services Research 2009, 9:145  doi:10.1186/1472-6963-9-145

Published: 11 August 2009



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.