ABSTRACT
We assessed whether an Assertive Outreach (AO) program for patients with schizophrenia implemented in German routine care in rural areas reduces psychiatric hospital admissions and/or psychiatric hospital days. We conducted a quasi-experimental controlled study with 5 assessments in 12 months. Data collection included health care utilization (Client Sociodemographic and Service Receipt Inventory), and clinical parameters. The assessments took place in the practices of the psychiatrists. Admission incidence rates were calculated. For bivariate group comparison, we used U-tests, T-tests and Chi(2)-Tests, multivariate analysis was conducted using zero-inflated regression models. For hospital outcomes, data of 295 patients was analysed. No statistically significant differences between AO and TAU patients in terms of hospital admissions or hospital days were found. Overall hospital utilization was low (8%). Advantages of AO over TAU referring to hospital utilization were not found. However, a spill-over effect might have reduced hospital utilization in both groups. Further research should differentiate patient subgroups. These two appear to be key factors to explain effects or absence of effects and to draw conclusions for the mental health care delivery.
Subject(s)
Community-Institutional Relations , Hospitalization/statistics & numerical data , Hospitals, Psychiatric/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Schizophrenia/therapy , Adult , Chi-Square Distribution , Female , Germany , Humans , Male , Middle Aged , Multivariate Analysis , Non-Randomized Controlled Trials as Topic , Outcome Assessment, Health Care , Regression Analysis , Rural Health Services/statistics & numerical dataABSTRACT
OBJECTIVES: The aim of the study was to analyze outpatient health care for demented individuals concerning the sustainability indicators coordination, cooperation and networking as well as finding solutions for present problems in those fields. METHODS: A systematic literature research in several relevant databases and telephone interviews with experts concerning outpatient care for demented individuals were conducted. The interviews were content analyzed. RESULTS: Deficits range from problems with financial compensation, difficulties on the interface of provided measures and lack of resources to individual factors as lack of knowledge, interest and willingness for intense coordination, cooperation and networking. CONCLUSION: Active promotion of patient centered, community and trans-sectoral health care as proposed in integrated care models seem to foster sustainability of outpatient health care for demented individuals.
Subject(s)
Alzheimer Disease/therapy , Ambulatory Care , Outcome Assessment, Health Care , Psychotherapy , Aged , Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Community Mental Health Services , Cooperative Behavior , Follow-Up Studies , Germany , Humans , Interdisciplinary Communication , Interview, PsychologicalABSTRACT
BACKGROUND: A model of assertive outreach (AO) in which office-based psychiatrists collaborate with ambulatory nursing services for providing intensive home-treatment is currently being implemented in rural areas of Lower Saxony, Germany. The costs of the model are reimbursed by some of the statutory health insurance companies active in Lower Saxony. Effectiveness and efficiency of this model for patients suffering from schizophrenia is evaluated in a pragmatic and prospective trial. METHODS: Quasi-experimental controlled trial: patients receiving the intervention are all those receiving AO; controls are patients not eligible for AO based on their health insurance affiliation. ELIGIBILITY CRITERIA: clinical diagnosis of schizophrenia (ICD-10 F.20), aged at least 18 years and being moderately to severely impaired in global functioning. PRIMARY OUTCOME: admission and days spent in psychiatric inpatient care; secondary outcomes: clinical and functional status; patient satisfaction with chronic care; health care costs. Follow-up time: 6 and 12 months. DISCUSSION: The study faces many challenges typical to pragmatic trials such as the rejection of randomisation by service providers, the quality of treatment as usual (TAU) to which the intervention will be compared, and the impairment of the study subjects. Solutions of how to deal with these challenges are presented and discussed in detail. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: http://ISRCTN34900108, German Clinical Trial Register: http://DRKS00003351.
Subject(s)
Community Mental Health Services/methods , Outpatients/psychology , Schizophrenia/therapy , Clinical Protocols , Community Mental Health Services/economics , Cost-Benefit Analysis , Germany , Humans , Long-Term Care , Patient Satisfaction , Research Design , Schizophrenia/economicsABSTRACT
OBJECTIVE: This study analyses deficits in outpatient care for depressed persons in Germany and seeks to identify possibilities for improvement. METHOD: Literature search and expert interviews. RESULTS: The outpatient depression care does not consider guidelines. A numerous possibilities to optimise outpatient treatment of depressive ill people were identified. CONCLUSIONS: Incentives should be systematically set to encourage services that are specific for treating chronic disorders. Systematic incentive for the improvement of the outpatient depression care should be given for example in particular for the achievements, which are important for the care of chronic disorders.
