Life expectancies in the UK are increasing and with this there is an increasing elderly population with more complex co-morbidity.
Treatment recommendations are less well defined for older women, who are rarely included in clinical trials and who often have more complex co-morbidities (Bastiaannet et al, 2010).
When applying the ACG system to our data from two of the three years in our study, we naturally found that the patients had more complex constellations of morbidity, and this was even more the case when expanding the period to all three years.
Complex morbidity requires more diverse and intensive care [ 25], which likely explains the higher contact frequency among patients with multimorbidity.
Apparently, more laboratory measurements were required in the interaction group, which may suggest that these patients were more severely ill or that they had more complex diseases or more co-morbidity.
The scenarios were simple cases of common conditions, and progressed to more complex cases with multiple co-morbidities in 3rd year.
This would allow specialist clinics, which are likely to be small in size, to focus on the diagnosis of new cases and providing more specialist support to AMHS for more complex cases with psychiatric co-morbidities.
Surgery for rectal cancer seems more complex and may result in increased morbidity and postoperative functional disorders (stoma, digestive, sexual, urinary) compared to colonic surgery.
As a result this study could not provide the level of information relating to more complex measures of maternal and perinatal morbidity as employed in other studies.
However, this fact, coupled with changing patient characteristics-patients are older, with greater morbidity and require more complex approaches-means that health care entails greater risks and a greater likelihood of causing damage to the patient.
