Development and evaluation of an evidence-based health information on benzodiazepines and z-drugs

Background

With approximately 1.1-1.4 million people in Germany taking benzodiazepines (BZDs) and z-drugs in a problematic or dependent manner, this is a relevant public health problem which needs to be adressed. However, it is well known that affected individuals do not receive the counseling or treatment they need. One possible solution is preventive education of affected individuals and medical practioners using evidence-based and target-group-health information (HI).The project EDER-MIA aimed to develop and evaluate evidence-based and target-group-related HI.

Methods

With the help of three different focus groups (18-40-years; women: 40-60-years; > 60-year-olds), the information needs of affected individuals were assessed. Based on the results, we developed the HI and received feedback from health experts. The HI was implemented online (http://www.psychenet.de) and evaluated with the ‘Usefulness Scale of Patient Information’ (USE): An assessment was made on 3 subscales with a 10-point scale from ‘1=disagree at all’ to ‘10=agree completely'. By forming a sum score (range: 0-90), an overall assessment was calculated.

Results

The results of the focus group study revealed the persons taking BZDs or z-drugs were in need about informations about sleep problems, the risk of taking BZDs and z-drugs and a better orientation regarding help services. The evaluation of the health information achieved medium acceptance rates of usefulness for affected persons (N = 192, 68.2% female; mean= 54.3, sd = 15.4). A somewhat higher usefulness was recognised by the medical staff (N = 58, 69.0% female, mean=64.7, sd = 17.2).

Conclusions

The development of target group-specific HI with the participation of affected individuals and experts is suitable for topics that are associated with possible experiences of shame and stigma. In addition to providing information about the risks of taking BZDs and z-drugs, screening of problematic BZD and z-drug use is also a matter of concern.

Key messages

• BZDs and z-drug use is a relevant public health concern which needs to be adressed.

• Target-group specific health information for BZD and z-drug use accompanied by a screening-test can encourage affected individuals to seek medical advice.

[Internet-based interventions in the treatment of mental disorders : Overview, quality criteria, perspectives]

BACKGROUND

Mental disorders are frequently not or only insufficiently treated. Internet-based interventions offer the potential of closing the existing gaps in the treatment of mental disorders; however, it is very difficult for patients and providers to choose from the numerous interventions available.

OBJECTIVE

The aim of this study was to develop a set of quality criteria that can help patients and care providers to identify recommendable internet-based interventions.

METHODS

A selective literature search was carried out and the existing evidence on internet-based interventions in the treatment of mental disorders was collated. A panel of experts then developed quality criteria based on existing models for the systematic assessment of telemedicine applications.

RESULTS

Internet-based interventions are effective in the treatment of a broad range of mental disorders. The best evidence is available for depression and anxiety disorders. A set of criteria is proposed for the evaluation of available internet-based interventions using a checklist. These criteria have to be developed further with input from other stakeholders.

DISCUSSION

When taking these quality criteria into account, evidence-based interventions available on the internet can make an important contribution to improvement of the care of patients with mental disorders.

[Data analysis based on the Classification of Therapeutic Procedures (CTL) of inpatient rehabilitation of depressive disorders]

OBJECTIVE

As an initiative of the German Pension Insurance Association (DRV), evidence-based therapeutic modules (ETM) for the rehabilitation of patients with depression were developed. The objective of the subsequent analysis was to analyse the therapeutic procedures in inpatient rehabilitation on the basis of the ETM to evaluate the principal needs for therapeutic standards.

METHODS

Data based on the German Classification of Therapeutic Procedures (KTL) for 21 529 patients treated in rehabilitation clinics for people with mental illnesses was analysed with respect to differences between diagnostic groups/clinics regarding type, quantity and duration of measures coded.

RESULTS

The mean quantity and duration of the interventions for patients with depressive disorders encoded varied greatly between the ETM. No or only minor differences were found between patients with depression and those with other diagnoses regarding the type, quantity and duration of measures coded. However, there were great variances between clinics.

CONCLUSIONS

Therapeutic standards for rehabilitative practice appear necessary in order to reduce treatment heterogeneity between rehabilitation facilities, which could improve the quality of healthcare.

Non-pharmacological treatment of depressive disorders: a review of evidence-based treatment options

BACKGROUND

The primary goals of this paper are to describe the collection and evaluation of various nonpharmacological treatment options for depressive disorders and to establish a basis for the development of a standard for the treatment of patients with depressive disorders.

METHOD

To identify evidence-based treatment elements, a comprehensive investigation of national and international guidelines was conducted. The extracted guidelines were then assessed with regard to aspects of methodological quality and evidence-based treatment elements. In a further step, specific and systematic literature searches for residual treatment elements were conducted. For the corresponding literature search, a hierarchical approach was chosen in which current guidelines were reviewed first and systematic reviews and meta-analyses second. Psychopharmacological treatments were excluded from the analysis because this is covered by specific guidelines.

RESULTS

The treatment elements with an adequate level of evidence were identified as follows: psychotherapeutic interventions, marital/couples/family therapy and counseling, inclusion of family members, psycho-education, exercise, problem solving therapy, guided self-help and behavioral activation treatments. Further evidence-based methods include diagnostic treatment elements, participative decision-making, development of the therapeutic alliance, Cognitive Behavioral Analysis System for Psychotherapy, computerized cognitive behavior therapy, psychopharmacological therapy, combined psychopharmacological and psychotherapeutic therapy, electroconvulsive therapy, phototherapy, sleep deprivation, repetitive trans-cranial magnetic stimulation (rTMS) and acupuncture.

CONCLUSION

In summary, using a hierarchical approach, it was possible to assign different levels of evidence to the various treatment options for depression.

Versorgungsforschung in der psychosozialen Medizin

The following article presents aspects of the field of psychosocial medicine in Germany from the perspective of health services research. First, the tasks and topics of health services research are listed. The identification and appropriate treatment of people with mental disorders is one of the core themes of psychosocial health care; therefore, a brief overview of research results on the epidemiology of mental disorders is first presented. The primary focus of this article is then to provide a description and analysis of the structures of psychosocial care in inpatient and outpatient settings. Research findings concerning treatment processes and the result of these processes are additionally presented. The findings show that there is still a considerable lack of research results regarding the treatment of patients with mental disorders, as is also the case in other health care areas. An important empirical basis for rationally founded treatment planning in this area is thus lacking.

[The development of a case group concept for patients with mental diseases]

In the year 2000 the German legislative decided to implement a case-dependent reimbursement system in an acute inpatient setting beginning in 2003. The German-Diagnoses Related Group System (G-DRGs) will adopt the refined version of the Australian-Diagnoses Related Group System (AR-DRG, version 4.1). Based on empirical data and expertś panels the acute psychiatric hospitals have been exempted from the adoption of the case-based payment system. With regard to national and international experiences in the development of patient classification systems in psychiatry and medical rehabilitation this article illustrates the development of a case group concept for patients with mental disorders.