| The process of becoming and being ill and its consequences is studied in relation to the home situation, the social network and the social environ-ment of the patient. The course of the disease and the prognosis are key issues in this programme. Also, the somatic and psychosocial determinants of prognosis, and the potential of self-management, informal care, assistive technology and supportive home care are subjects of study. The focus of this programme is on chronic illness, the prevalence of which in the 15 years to come is expected to increase by approximately 40%. Knowledge is accumulated and theories are developed with respect to general dimensions, determinants and implications of chronic illness, and related to important specific health problems and disorders. Insight is gained into 'careers' of chronic patients and their relatives over time, with a special focus on (a) course and determinants of chronic disease and (b) functional autonomy and social support. As to the course and determinants of chronic disease, the early development (including preclinical), the later course and the prognosis are studied as well as somatic, psychological and social determinants. Long-term research projects address frequently occurring chronic disorders with a considerable individual and community burden of illness such as asthma, COPD, cardiovascular disease, musculoskeletal disorders, diabetes, mental disorders and dementia. Special attention is paid to the monitoring of chronic illness over time, the increasin-gly important problem of multi-morbidity in the elderly and the consequences for autonomy and quality of life of the patients. The research usually requires a longitudinal design, suited for long-term guidance and monitoring. Therefore, systematic longitudinal recording of morbidity in dynamic populations is a basic instrument. This is facilitated by a nationwide primary care research network of computer-assisted morbidity registers, in which patient (n= 800,000) and morbidity data are continuously registered and updated. Regarding functional autonomy and social support, implications of being chronically ill are studied in relation to the home situation, the social network and the social environment. Because of demographic changes (ageing population, smaller families, more mobility) the societal consequences of (chronic) illness becomes more visible while the supportive informal care is under considerable pressure. More insight is needed into the 'careers' of chronic patients and their relatives, and the possibilities of selfmanagement, volunteer aid, supporting home care and rehabilitation. Relevant aspects are the patient's functioning in the home situation, the social or working environment, the dependence on health care, the patient's course in the health care circuit, and the provided care observed from the patient's perspective. Functional autonomy, participation in working and social environment, coping behaviour and quality of life are important, mutually interacting, study variables. Studies are also aimed at the interface between non-professional (informal) and professio-nal care, and the determinants of the needs and demands for care. |
