1
|
Bechdolf A, Bühling-Schindowski F, Nikolaidis K, Kleinschmidt M, Weinmann S, Baumgardt J. [Evidence on the effects of crisis resolution teams, home treatment and assertive outreach for people with mental disorders in Germany, Austria and Switzerland - a systematic review]. Nervenarzt 2021; 93:488-498. [PMID: 34114073 DOI: 10.1007/s00115-021-01143-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Based on international randomized controlled trials (RCT) the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) recommends acute treatment in the domestic environment (AHU) and intensive outreach treatment (IAB) with the highest level of evidence; however, due to large differences in national healthcare systems the transference of results from international studies to the healthcare systems in Germany, Austria and Switzerland could be limited. OBJECTIVE Evaluation of studies on outreach psychiatric treatment forms in Germany, Austria and Switzerland and discussion of the results in the light of international evidence. MATERIAL AND METHODS A systematic literature search for clinical trials on outreach community treatment from Germany, Austria and Switzerland was conducted in the PubMed database. RESULTS A total of 19 publications were identified which could be assigned to 5 publications on 4 studies with 2857 patients on AHU and 14 publications on 10 studies with 3207 patients on IAB. The studies on AHU showed this treatment form to be superior regarding the duration of inpatient stay and healthcare costs. The studies on IAB showed more positive outcomes in comparison to controls regarding symptoms, severity of illness, substance abuse, functioning level, remission, satisfaction with treatment, quality of life, healthcare costs, work and housing situations. CONCLUSION The studies from Germany, Austria, and Switzerland suggest that outreach community treatment is superior regarding several outcome parameters. Thus, there are no indications suggesting that international evidence could not be valid for these countries. Additionally, with one RCT for AHU and one for IAB the requirements for an evidence level of 1b for outreach community treatment in the healthcare systems in question are fulfilled.
Collapse
Affiliation(s)
- Andreas Bechdolf
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland. .,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln, Köln, Deutschland. .,ORYGEN, National Center of Excellence of Youth Mental, Health, University of Melbourne, Melbourne, Australien.
| | - Felix Bühling-Schindowski
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
| | - Konstantinos Nikolaidis
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
| | - Martin Kleinschmidt
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
| | - Stefan Weinmann
- Klinik für Psychiatrie und Psychotherapie, Rudolf-Sophien-Stift, Stuttgart, Deutschland.,Universitätsspital Basel, Basel, Schweiz
| | - Johanna Baumgardt
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
| |
Collapse
|
2
|
von Peter S, Ignatyev Y, Johne J, Indefrey S, Kankaya OA, Rehr B, Zeipert M, Bechdolf A, Birkner T, Deister A, Duve A, Rout S, Scherk H, Schulz-Dubois A, Wilms B, Zedlick D, Grollich P, Braun B, Timm J, Heinze M. Evaluation of Flexible and Integrative Psychiatric Treatment Models in Germany-A Mixed-Method Patient and Staff-Oriented Exploratory Study. Front Psychiatry 2018; 9:785. [PMID: 30723433 PMCID: PMC6349706 DOI: 10.3389/fpsyt.2018.00785] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
Contrary to the practice in some countries, access to flexible and integrated forms of psychiatric care (FIT models) is limited in Germany. Several legislations have been introduced to improve this situation, notably the recent §64b (flexible and integrative treatment model; FIT64b) of the German Social Code, which allows for a capitation-based accounting of fees for services. The aim of this study was to explore the effects of FIT64b implementation on various stakeholders (patients, informal caregivers and staff) in 12 psychiatric hospital departments across Germany. Structural as well as quantitative and qualitative data are included, with integration of different methodological approaches. In all departments, the implementation of the new accounting system resulted into a relatively stable set of structural and processual changes where rigid forms of mainly inpatient care shifted to more flexible and integrated types of outpatient and outreach treatments. These changes were more likely to be perceived by patients and staff, and likewise received better evaluations, in those departments showing higher level or longer duration of implementation. Patients' evaluations, furthermore, were largely influenced by the advent of continuous forms of care, better accessibility, and by their degree of autonomy in steering of their services.
Collapse
Affiliation(s)
- Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Yuriy Ignatyev
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Jakob Johne
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Sonja Indefrey
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Onur Alp Kankaya
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Burkhard Rehr
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Manfred Zeipert
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany.,Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, Vivantes Krankenhaus am Urban, Charité University Medicine Berlin, University of Cologne, Berlin, Germany
| | - Thomas Birkner
- Department for Psychiatry, Psychotherapy and Psychosomatic Medicine, Westklinikum Heide, Heide, Germany
| | - Arno Deister
- Psychosoziales Zentrum Itzehoe, Itzehoe, Germany
| | - Annette Duve
- Department of Child and Adolescent Psychiatry, Vitos Klinikum Riedstadt, Riedstadt, Germany
| | - Sandeep Rout
- Department of Psychiatry and Psychotherapy, Vivantes Krankenhaus Neukölln, Charité University Medicine Berlin, Berlin, Germany
| | - Harald Scherk
- Department of Psychiatry and Psychotherapy, Vitos Klinikum Riedstadt, Riedstadt, Germany
| | - Anna Schulz-Dubois
- Department of Psychiatry and Psychotherapy, Imland Krankenhaus Rendsburg, Rendsburg, Germany
| | - Bettina Wilms
- Department of Psychiatry and Psychotherapy, Basedow Klinikum Saalekreis, Querfurt, Germany
| | - Dyrk Zedlick
- Department of Psychiatry and Psychotherapy, Rudolf Virchow Krankenhaus Glauchau, Glauchau, Germany
| | - Peter Grollich
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Bernard Braun
- SOCIUM Research Center, University of Bremen, Bremen, Germany
| | - Jürgen Timm
- Biometry Section, Competence Center for Clinical Trials, University of Bremen, Bremen, Germany
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| |
Collapse
|