Table 1

Overview of case vignettes

DemographyPsychosocial contextDiagnoses
Epidemiologically confirmed disease patterns 25
91 years, male
(figure 1)
His wife suffered a stroke; the couple lives secludedDepression, dementia, coronary heart disease (+ urinary incontinence and hearing loss)
66 years, female
(see online supplementary file 3)
Retired, no further informationChronic back pain, osteoporosis, headaches
82 years, female
(see online supplementary file 4)
Immigrated, speaks no GermanChronic heart failure, chronic kidney failure, low blood pressure
55 years, female
(see online supplementary file 5)
Immigrated, familial problems, does not speak German wellHigh blood pressure, type 2 diabetes mellitus, metabolic syndrome
Most frequently encountered disease combinations 26
82 years, male
(see online supplementary file 6)
Widowed, lives alone, daughter visits every 4 weeksHigh blood pressure, atrial fibrillation, depression
60 years, male
(see online supplementary file 7)
Dock worker, shift work, smokerHigh blood pressure, coronary artery disease, chronic back pain
84 years, female
(see online supplementary file 8)
Lives alone, ambulatory care gives medicationsAtrial fibrillation, heart failure, dementia, fatigue
Highly complex real cases, reported by participating GPs
76 years, male
(see online supplementary file 9)
Lives alone, ex-wife cares for him, speech problemsHigh blood pressure, high cholesterol, stroke, peripheral arterial disease, combined mitral valve defect
80 years, male
(see online supplementary file 10)
Retired, no further informationHigh blood pressure, high cholesterol, atrial fibrillation, chronic heart failure, diabetes mellitus with kidney failure and cerebral microangiopathy, coronary heart disease, multicausal gait disturbance, sleep apnoea
66 years, female
(see online supplementary file 11)
Retired, lives alone, no further informationHigh blood pressure, high cholesterol, chronic back pain, type 2 diabetes mellitus, polymyalgia rheumatica with arteritis temporalis, osteoporosis
  • GPs, general practitioners.