Patient competence in relation with medical and psychosocial characteristics in cardiology context: A cross-sectional study.

BACKGROUND: Growth of cardiovascular disease (CVD), variation in provision of medical services, rising costs, and increasing information availability through the media are making patients more actively involved in decision-making process of their treatment. The aim of this study was to better understand the components of patient competence in the context of coronary artery disease (CAD) and to further evaluate their relations with medical, demographic, and psychosocial characteristics. METHODS: In this cross-sectional study, 148 patients with at least one year diagnosis of acute coronary syndrome (ACS) were enrolled in the study from April to June 2014. Data on demographic characteristics, depression, anxiety, quality of life (QOL), social support, and drug adherence were collected from participants. Pearson correlation, one way analysis of variance (ANOVA), and multiple linear regression tests were performed for analyzing data. RESULTS: The mean age of patients was 53.63 ± 5.15. Of the participants, 58 (39.5%) and 61 cases (41.5%) were found to be depressed and anxious, respectively. Higher levels of self-regulation correlated with higher education years and social support, and also with lower depression and anxiety (P < 0.050). Stress management and confronting the threat were linked to education years, depression, anxiety, QOL, and social support (P < 0.050). CONCLUSION: The patients with CAD, in order to be involved in the proper treatment process and manage their emotions during this process, need to have the required competencies. Patient competence as a whole and its components have been related to medical, demographic, and psychosocial characteristics.

Symptom course in inpatient and day clinic treatment of depression: Results from the INDDEP-Study.

BACKGROUND: In major depression (MDD), hospital treatment is an option in more severe cases or if outpatient treatment failed. Psychosomatic hospitals in Germany provide treatment programs with multimodal psychotherapy, either in an inpatient or a day hospital setting. In the context of health care research, this study aimed (1) to compare characteristics of patients treated in psychosomatic day hospitals and inpatient units, (2) to compare the effectiveness of both treatment modalities. METHODS: A naturalistic design was chosen to achieve external validity. 604 consecutive patients were assessed at admission, discharge and a 3-month follow-up. Primary outcome was defined as a reduction of depressive symptomatology (QIDS-C), secondary outcomes comprise overall functioning and quality of life. For a comparison of effectiveness, inpatient and day hospital samples were matched according to known predictors of outcome. RESULTS: The few differences found between the inpatient and day hospital sample were related to severity of depression and physical impairment. Inpatients more often got antidepressant medication. Additionally, inpatients were treated significantly longer, due to a subgroup of patients with somatic co-morbidity. There were no differences when comparing effectiveness. LIMITATIONS: When comparing treatment effectiveness, possible bias cannot be ruled out. There was no randomization or untreated control group. CONCLUSIONS: In patients with a more severe depression and somatic co-morbidity, inpatient treatment might be preferred as compared to day hospital treatment. However, most patients can be treated in both settings.

[Results of the pilot project of the Techniker-Krankenkasse "quality monitoring in outpatient psychotherapy" - a commentary by the project's scientific advisory board]. / Zu den Ergebnissen des Modellprojektes der Techniker-Krankenkasse zum Qualitätsmonitoring in der ambulanten Psychotherapie - eine Replik des wissenschaftlichen Beirats.

In order to objectify the discussion about a project of the TK, a German health insurance company, which aimed to analyse the effects of a specific quality monitoring system on psychotherapy outcomes, the scientific advisory board summarized the main results of the study. The main results were cited from the final report which confirms the confirmatory character of the study design that aimed to test the hypothesis of the superiority of the quality monitoring system compared to the system of peer review-based approval of therapies. The quality monitoring system represents a complex intervention which is composed of several single intervention elements. Thus, the study results allow only the conclusion that the overall complex interven-tion did not prove to be superior. Further studies are needed with regard to the effectiveness of single components. Finally, the issues of representativeness and selectivity of the study and the sample are discussed and their importance is -underlined by reference to the literature.