Petra Thürmann

Clinically important drug interactions with anticoagulants. An update.

SummaryCoumarin derivatives combine 3 unfavourable properties which make them prone to potentially life threatening drug-drug interactions: (i) high protein binding; (ii) cytochrome P450 dependent metabolism; and (iii) a narrow therapeutic range.An entire list of drugs which are supposed to interact with coumarins (mostly with warfarin) comprises about 250 different compounds. Noteworthy are the interactions with cardiovascular or antilipidaemic drugs which are often coadministered with coumarins: amiodarone, propafenone and fibrates. Cardiovascular drugs which are obviously devoid or proven to be devoid of an interaction are angiotensin converting enzyme (ACE) inhibitors, calcium antagonists, β-blockers and cardiac glycosides. There are several other drugs which enhance the hypopro-thrombinaemic response to coumarins by various mechanisms: inhibitors of the elimination of the eutomer S-(−)-warfarin (e.g. miconazole, phenylbutazone), combined with protein binding displacement (e.g. sulfinpyrazone, phenylbutazone), synergistic hypoprothrombinaemia (e.g. cefazoline). Furthermore, bleeding complications may occur with drugs affecting platelet function [aspirin (acetylsali-cylic acid) and several nonsteroidal anti-inflammatories (NSAIDs)]. Strong inducers of coumarin metabolism are rifampicin (rifampin) and carbamazepine. Biphasic interactions may occur where a drug first enhances the hypoprothrombinaemic response to a coumarin but has a sustained inducing effect on coumarin metabolism (e.g. phenytoin or sulfinpyrazone).The complex response of coumarins to concomitant drug therapy makes it difficult to predict the occurrence and degree of a deterioration of anticoagulant control in individual patients. For clinical practice, it seems advisable that one should monitor for changes in prothrombin time when adding or deleting any newly approved drug or any drug suspected (e.g. on the basis of this review) to cause an interaction to patients on coumarin therapy. The onset of the adverse prothrombin time response might be from between 1 to 2 days up to 3 weeks (in case of phenprocoumon) after starting a concomitant drug regimen. With amiodarone, an adverse prothrombin time response might occur up to 2 months after initiating therapy.For heparins, only a drug interaction with aspirin or nitroglycerin seems clinically relevant due to the possibility of coadministration during acute cardiac events. Both drugs are shown to enhance the activated partial thromboplastin time response to heparin.

Deutsche Empfehlungen zur gesundheitsökonomischen Evaluation

Zusammenfassung□ Finanzielle Restriktionen und eine stärkere Ergebnisorientierung erfordern mehr und mehr rationale Entscheidungen über den Mitteleinsatz im Gesundheitswesen. Solche Entscheidungen sind Gegenstand medizinischer, ethischer und wirtschaftlicher Erwägungen. Die Steuerung des Gesundheitswesens bedarf sowohl auf gesamtwirtschaftlicher Ebene der medizinischen und wirtschaftlichen Orientierung als auch bei der Auswahl von geeigneten Versorgungsformen in Klinik und Praxis. Die evaluative Gesundheitsökonomie kann dabei ein wichtiges Hilfsmittel zur Entscheidungsfindung sein.□ Damit die Ergebnisse von gesundheitsökonomischen Evaluationsstudien valide interpretiert werden können, ist ein Mindestmaß an gemeinsamer Methodik und ausreichender Transparenz erforderlich. Zu diesem Zweck wurden Empfehlungen entwickelt. Sie sollen einerseits Standards vermitteln, andererseits den methodischen Fortschritt und die wissenschaftliche Freiheit in der Gesundheitsökonomie nicht unnötig einengen.□ Für die Zukunft ist eine ständige Weiterentwicklung der Empfehlungen und ihre Anpassung an den jeweiligen Stand der gesundheitsökonomischen Forschung anzustreben.Abstract□ Financial restrictions and stronger orientation towards outcomes increasingly demand rational decisions to be made about the use of resources in the health care system. Such decisions are the subject of medical, ethical and economic considerations. Management of the health care system requires medical and economic orientation both at the general level and with regard to the selection of suitable forms of care in hospital and medical practices. In this context, evaluative health economics can be a valuable decision-making aid.□ In order for the results of health economic evaluation studies to be validly interpreted, a minimum of standard methodology and sufficient transparency is required. To this end, recommendations were developed. They are intended to convey standard approaches, without unnecessarily constraining methodologic progress and scientific freedom.□ Ongoing refinement of the guidelines and adaptation of the current state of health economic research are desirable.

Methods and Systems to Detect Adverse Drug Reactions in Hospitals

Detection of adverse drug reactions (ADRs) in hospitals offers the chance to detect serious ADRs resulting in hospitalisation and ADRs occurring in hospitalised patients, i.e. patients with high comorbidity and receiving drugs that are administered only in hospitals. The most commonly applied methods involve stimulated spontaneous reporting of doctors and nurses, comprehensive collection by trained specialists and, more recently, computer-assisted approaches using routine data from hospital information systems. The different methods of ADR detection used result in different rates and types of ADRs and, consequently, in different drug classes being responsible for these ADRs. Another factor influencing the results of surveys is the interpretation of the term ADR, where some authors adhere to the strict definition of the World Health Organization and many others include intended and unintended poisoning as well as errors in prescribing and dispensing, thus referring to adverse drug events. Depending on the method used for screening of patients, a high number of possible ADRs and only few definite ADRs are found, or vice versa. These variations have to be taken into account when comparing the results of further analyses performed with these data. ADR rates and incidences in relation to the number of drugs prescribed or patients exposed have been calculated in only a few surveys and projects, and this interesting pharmacoepidemiological approach deserves further study. In addition, the pharmacoeconomic impact ofADRs, either resulting in hospitalisation or prolonging hospital stay, has been estimated using different approaches. However, a common standardised procedure for such calculations has not yet been defined. Although detection of ADRs in hospitals offers the opportunity to detect severe ADRs of newly approved drugs, these ADRs are still discovered by spontaneous reporting systems. The prospects offered by electronic hospital information systems as well as implementation of pharmacoepidemiological approaches increases the possibilities and the value of ADR detection in hospitals.

Structure and activities of hospital drug committees in Germany

AbstractObjectives: Hospital drug committees have been established to ensure rational drug use. However, with regard to their structure and duties remarkable differences between European countries may exist, reflecting the differences in drug legislation and market. Our aim was to obtain information about the structure, present activities and decision-making processes of hospital drug committees in Germany and especially the role of clinical pharmacologists in these committees. Methods: In 1995, a questionnaire with 36 items was designed and sent to all 450 hospitals in Germany with more than 400 beds. One hundred forty three returned questionnaires were evaluated. Results: According to hospital size, the median value for the annual drug budget (including the cost of blood and blood-derived products) in 1993 ranged between DM 2.4 million for hospitals with less than 500 beds and DM 30.0 million for university hospitals with more than 1 000 beds. In 53.2% of drug committees, a pharmacist holds the position of chairman, followed by medical specialists (32%); (clinical) pharmacologists hold this position in only 7.7% of the general hospitals, but in almost 50% of the university hospitals. In most cases, all clinical specialities are represented in the drug committee, the number of members ranging between 5 and 40 (median 12). The number of drugs included in the internal drug list, ranging between 400 in hospitals with <500 beds and about 700 in university hospitals, strongly correlated with the number of beds and, interestingly, with the number of drug committee members. Treatment guidelines were implemented mainly for anti-infectives (87%), infusion solutions (30%), anti-emetic drugs (5-HT3-receptor antagonists, 27%) and blood and blood-derived products such as intravenous immunoglobulins (23%). However, effective control of these guidelines was only performed in about 50% of the hospitals. A drug information service was provided in most hospitals, where 95% of queries were answered by pharmacists. Conclusion: The results of our survey showed that German hospital drug committees vary considerably with regard to their function and control mechanisms of drug use. Most of the responders would appreciate a more intensive exchange of current problems and treatment guidelines. Although the process of pharmacotherapeutic decision making should be supported by clinical pharmacologists, experts in this field are often not involved in German hospital drug committees.

Detecting adverse drug reactions on paediatric wards: intensified surveillance versus computerised screening of laboratory values.

AbstractBackground: Adverse drug reactions (ADRs) contribute significantly to patient morbidity and mortality, as well as to costs for healthcare systems. Our aim was to evaluate the type and incidence of ADRs in a paediatric hospital population, comparatively ascertained by two different methodological approaches. Methods: Our prospective study enrolled all patients admitted to two of the general children wards (46 beds) and the paediatric intensive care unit (6 beds) at the HELIOS Klinikum Wuppertal teaching hospital in Germany, over the study period of 3 months. We used two methods to detect ADRs. The intensified surveillance system relied on a trained physician conducting ward rounds and assessing patient charts. The computer-assisted screening of pathological laboratory parameters used values slightly below or above the age-specific normal range as a trigger signal for a potential ADR, which was subsequently assessed by trained personnel. Results: By applying both methods simultaneously we observed that 14.1% of children experienced an ADR while they were hospitalised and 2.7% of children were admitted to hospital because of the ADR. Intensified surveillance resulted in the detection of 101 ADRs in 11.9% of patients, predominantly presenting with gastrointestinal symptoms, skin and CNS disorders; computer-assisted screening identified 45 ADRs in 5.7% of patients, mainly with drug-induced blood dyscrasia and liver damage. Furthermore, the ADRs detected by the intensified method were more severe, affected younger children and showed a closer causal attributability to the reaction than the ADRs observed by the computerised method. The spectra of drugs involved were similar, with the anti-infectives being suspected most frequently. The sensitivities of the intensified surveillance system and the computerised surveillance screening came to 67.2% and 44.8%, respectively, with computer-assisted screening having a specificity of 72.8%. The mean positive predictive value of the pathological laboratory values under surveillance by computer-assisted screening was 18.6%. Approximately 25% of ADR-related drugs administered were used for off-label indications. Conclusion: Using the published literature for comparison, we found that ADRs occur as frequently in paediatric patients as in adult patients. Intensified surveillance and computerised surveillance applied in the paediatric setting show substantial differences in their detection specificities. A higher number of and more severe ADRs can be detected by intensified surveillance than by computerised surveillance, but require higher personnel resources.

Prerequisites for a new health care model for elderly people with multimorbidity

Fragestellung Das gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbiditat stellt den betroffenen Patienten, seine Angehorigen sowie Arzte und Therapeuten vor grose Herausforderungen. Das Gesundheitssystem wird durch die steigende Zahl Betroffener und ihre komplexen Bedurfnisse, aber auch durch die Vielfalt haufig schlecht koordinierter Interventionen zunehmend belastet. Zur Verbesserung der medizinischen Versorgung bietet sich das fur chronisch Kranke entwickelte „Chronic Care Model“ an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen fur ein daran orientiertes, neues Versorgungsmodell fur multimorbide, altere Patienten zu schaffen.BackgroundMultimorbidity, the concurrent manifestation or presence of multiple chronic conditions, poses huge challenges to affected patients, their relatives, physicians, and practitioners alike. The growing number of affected persons and the complexity of their needs places just as much of a burden on the health care system as does the plethora of often poorly coordinated interventions. The Chronic Care Model developed for different chronic diseases is suited for improving medical care. The PRISCUS research consortium was established to create the prerequisites for a new care model for multimorbid, elderly patients oriented along those lines.MethodsThe research consortium utilizes data gathered in a large-scale epidemiological study on peripheral arterial disease (getABI study) and from the Dortmund and Münster stroke registries, by extracting epidemiologic and health economic data, quality-of-life parameters, and data on the extent and quality of medication. Additional projects evaluate the implementation of a multidimensional geriatric assessment in primary care, the functional consequences of multimorbidity in stroke patients along with options for prevention and therapy afforded by physical activity. Systematic reviews of the literature are used to describe quality of life and patient preferences. Experts will work on an initial draft treatment standard for patients with multimorbidity and a list of potentially inappropriate medication for the elderly in Germany.ConclusionThe results of the PRISCUS research consortium will enable an epidemiologic characterization and description of consequences of multimorbidity, while illustrating new approaches towards prevention, diagnosis, and management of multimorbid patients. With this, some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model will be fulfilled.ZusammenfassungFragestellungDas gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbidität stellt den betroffenen Patienten, seine Angehörigen sowie Ärzte und Therapeuten vor große Herausforderungen. Das Gesundheitssystem wird durch die steigende Zahl Betroffener und ihre komplexen Bedürfnisse, aber auch durch die Vielfalt häufig schlecht koordinierter Interventionen zunehmend belastet. Zur Verbesserung der medizinischen Versorgung bietet sich das für chronisch Kranke entwickelte „Chronic Care Model“ an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen für ein daran orientiertes, neues Versorgungsmodell für multimorbide, ältere Patienten zu schaffen.MethodikDer Verbund nutzt unter anderem Daten einer großen epidemiologischen Studie zur peripheren arteriellen Verschlusskrankheit (getABI-Studie) und Daten des Dortmunder und Münsteraner Schlaganfallregisters. Ermittelt werden epidemiologische und gesundheitsökonomische Daten, Parameter der Lebensqualität und Umfang und Qualität der medikamentösen Versorgung. In weiteren Projekten werden die Implementierung eines multidimensionalen Assessments in Hausarztpraxen, die funktionellen Auswirkungen von Multimorbidität bei Schlaganfallpatienten sowie Möglichkeiten der Prävention und Therapie mittels körperlicher Aktivität evaluiert. Über systematische Literaturübersichten werden Lebensqualität und Patientenpräferenzen dargestellt. Mit Hilfe von Experten wird ein erster Behandlungsstandard für Patienten mit Multimorbidität und eine Liste potentiell inadäquater Medikamente im Alter erarbeitet.FazitDie Ergebnisse des Forschungsverbunds werden eine epidemiologische Charakterisierung und eine Abschätzung der Krankheitsfolgen von Multimorbidität erlauben. Der Verbund wird neue Ansätze zu Prävention, Diagnostik und Therapie bei Multimorbidität aufzeigen können. Damit werden erste Voraussetzungen geschaffen, durch Anpassung der Versorgungsstruktur nach Vorbild des „Chronic Care Model“ ein verbessertes Management von Patienten mit Multimorbidität zu erreichen.

Association between Potentially Inappropriate Medication (PIM) Use and Risk of Hospitalization in Older Adults: An Observational Study Based on Routine Data Comparing PIM Use with Use of PIM Alternatives

Objective The safety of potentially inappropriate medications (PIMs) in elderly patients is still debated. Using the PRISCUS list, we examined the incident all-cause hospitalization risk associated with PIMs compared to PIM alternatives during the 180 days post individual first pharmacy dispensing (index date). Methods Routine claims data from a German health insurer on 392,337 ambulatory patients aged ≥65 years, were used to estimate adjusted hazard ratios (HRs) for hospitalization associated with incident PIM use. Observation period was January 2009 –December 2010. Users of PIM alternatives, as defined by the PRISCUS list, were the reference group. Patients with PIM dispensing or hospital stay in a six month “washout” period (second half of 2008) were excluded. All potential confounders were determined in the half year before the individual index date. Results In the total cohort 60.7% were female. Median age was 73 years. Of 79,041 incident PIM users, 58.4% had PIMs dispensed in one quarter of 2009 or 2010, 19.3% in two quarters, and 22.3% in three or more quarters. There were 126,535 hospitalizations during the observation period, and 47,470 of them occurred within 180 days post first dispensing. Multivariable Cox regression analysis revealed PIM use as a significant risk factor for hospitalization (HR 1.378; 95% CI 1.349–1.407) compared to use of PIM alternatives. Conclusions PIM use compared to use of PIM alternatives is associated with an increased risk of all-cause hospitalization in the 180 days following individual index date. Future analyses comparing a single PIM with its corresponding alternative may help identify those PIMs responsible for this.

Lycopene for advanced hormone refractory prostate cancer: a prospective, open phase II pilot study.

PURPOSE We investigated the influence of lycopene on the clinical and laboratory course in men with hormone refractory prostate cancer. To our knowledge this study represents the first time that subjective assessments of the course of therapy have been recorded. MATERIAL AND METHODS We performed a prospective, open phase II pilot study, in which patients with progressive hormone refractory prostate cancer were included. Lycopene supplementation (15 mg) was given daily for 6 months. Followup laboratory tests and clinical examinations were done monthly. Changes to analgesic use and quality of life (European Organisation for Research and Treatment of Cancer QLQ-C30) were measured. The study end point was a significant change in serum prostate specific antigen, clinical progression or the end of the 6-month observation period. RESULTS A total of 18 patients 64 to 85 years old (median age 73) were enrolled in the study during a 20-month period, of whom 17 could be analyzed. Five of the 17 patients (29%) withdrew from the study prematurely, including 4 of 5 because of prostate specific antigen progression and/or tumor associated complications, and 1 due to an allergic reaction to lycopene. Median prostate specific antigen doubled in 6 months from 42.7 ng/ml (range 13.8 to 521.6) in 17 patients to 96.4 ng/ml (range 13.5 to 1,240) in 12. Stable prostate specific antigen was observed in 5 of 17 patients (29%). None of the patients had a greater than 50% decrease in prostate specific antigen. Patients experienced a slight deterioration in mean health status at the end of the study compared to the outset. However, two-thirds of the patients experienced an improved or unchanged situation regardless of the clinical and biochemical course. CONCLUSIONS No clinically relevant benefits were shown for patients with advanced stages of the disease.

[Prerequisites for a new health care model for elderly people with multiple morbidities: results and conclusions from 3 years of research in the PRISCUS consortium].

BACKGROUND The concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model. METHODS AND RESULTS Four out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug-drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs. CONCLUSIONS The results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.ZusammenfassungHintergrundDas gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbidität stellt den Betroffenen und seine Angehörigen, Ärzte und Therapeuten, aber auch das Gesundheitssystem vor große Herausforderungen. Für eine verbesserte medizinische Versorgung bietet sich das für chronisch Kranke entwickelte Chronic Care Modell an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen für ein daran orientiertes, neues Versorgungsmodell für multimorbide, ältere Patienten zu schaffen.Methoden und ErgebnisseÜbersichtsartig werden Ergebnisse aus vier der insgesamt sieben Teilprojekte des Forschungsverbunds dargestellt. Im sportmedizinischen Teilprojekt geht es um die Erfassung körperlicher Aktivität über ein neues Fragebogeninstrument sowie die Entwicklung eines Heimübungsprogramms für chronisch kranke und in der Mobilität eingeschränkte Ältere. Das allgemeinmedizinische Teilprojekt befasst sich mit der Implementierung eines geriatrischen Assessments in der hausärztlichen Versorgung sowie dessen Auswirkungen. Im pharmakologischen Teilprojekt geht es um potenziell inadäquate Medikation für Ältere, Interaktionen und Nebenwirkungen. Das gesundheitsökonomische Teilprojekt eruiert Auswirkungen von Multimorbidität bei Älteren auf Lebensqualität und gesundheitsassoziierte Kosten.SchlussfolgerungDie Ergebnisse des Forschungsverbunds erlauben eine Abschätzung der Krankheitsfolgen von Multimorbidität und zeigen einige neue Ansätze zu Prävention, Diagnostik und Therapie bei Multimorbidität auf. Folgeprojekte werden sich mit der Wirksamkeit eines hausärztlich vermittelten, multidimensionalen Bewegungsprogramms sowie mit einem Interventionsprogramm zur Reduktion potenziell inadäquater Medikation bei Älteren befassen. Damit werden erste Voraussetzungen geschaffen, durch Anpassung der Versorgung nach Vorbild des Chronic Care Modell ein verbessertes Management von Patienten mit Multimorbidität zu erreichen.AbstractBackgroundThe concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model.Methods and resultsFour out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug–drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs.ConclusionsThe results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.

Voraussetzungen für ein neues Versorgungsmodell für ältere Menschen mit Multimorbidität

BACKGROUND The concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model. METHODS AND RESULTS Four out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug-drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs. CONCLUSIONS The results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.ZusammenfassungHintergrundDas gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbidität stellt den Betroffenen und seine Angehörigen, Ärzte und Therapeuten, aber auch das Gesundheitssystem vor große Herausforderungen. Für eine verbesserte medizinische Versorgung bietet sich das für chronisch Kranke entwickelte Chronic Care Modell an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen für ein daran orientiertes, neues Versorgungsmodell für multimorbide, ältere Patienten zu schaffen.Methoden und ErgebnisseÜbersichtsartig werden Ergebnisse aus vier der insgesamt sieben Teilprojekte des Forschungsverbunds dargestellt. Im sportmedizinischen Teilprojekt geht es um die Erfassung körperlicher Aktivität über ein neues Fragebogeninstrument sowie die Entwicklung eines Heimübungsprogramms für chronisch kranke und in der Mobilität eingeschränkte Ältere. Das allgemeinmedizinische Teilprojekt befasst sich mit der Implementierung eines geriatrischen Assessments in der hausärztlichen Versorgung sowie dessen Auswirkungen. Im pharmakologischen Teilprojekt geht es um potenziell inadäquate Medikation für Ältere, Interaktionen und Nebenwirkungen. Das gesundheitsökonomische Teilprojekt eruiert Auswirkungen von Multimorbidität bei Älteren auf Lebensqualität und gesundheitsassoziierte Kosten.SchlussfolgerungDie Ergebnisse des Forschungsverbunds erlauben eine Abschätzung der Krankheitsfolgen von Multimorbidität und zeigen einige neue Ansätze zu Prävention, Diagnostik und Therapie bei Multimorbidität auf. Folgeprojekte werden sich mit der Wirksamkeit eines hausärztlich vermittelten, multidimensionalen Bewegungsprogramms sowie mit einem Interventionsprogramm zur Reduktion potenziell inadäquater Medikation bei Älteren befassen. Damit werden erste Voraussetzungen geschaffen, durch Anpassung der Versorgung nach Vorbild des Chronic Care Modell ein verbessertes Management von Patienten mit Multimorbidität zu erreichen.AbstractBackgroundThe concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model.Methods and resultsFour out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug–drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs.ConclusionsThe results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.