Limitations
multiple chronic diseases, impaired mood
MULTIPLE CHRONIC DISEASES
Although we reached a comprehensive sample size in the context of geriatric research, which formed a sound basis for the statistical analyses, some limitations should be mentioned. Potential bias could result from the regional specificity and the exclusion criteria applied. The study area was restricted to Freiburg and surrounding areas. Specific characteristics of this area, like the relatively high socioeconomic performance, might have influenced the implementation of the intervention and study results. Therefore, future studies should investigate similar health care approaches for older people with multiple chronic diseases in other German areas for comparison. In addition, we did not include patients with terminal conditions or insufficient German language skills. These factors could likely be conditions occurring in the population of older multimorbid people and in ethnically diverse societies, which pose specific demands on the care management; therefore, they should be explored in future research.Finally, the effect of the COVID-19 pandemic cannot be ruled out. From the beginning of 2020, several study procedures were adapted to the pandemic situation. The monitoring and closing sessions of the intervention were then primarily provided by telephone. In principle, this was not an issue of particular concern because the intervention design and manual had already included telephone contacts between the CCM and patients. Moreover, the telephone contacts were feasible in most cases. Nevertheless, the general negative effects of the COVID-19 pandemic, such as restricted contacts, reduced doctor visits, or impaired mood, could have interfered with the intervention and influenced the evaluation of its effectiveness.