Outpatient Psychotherapy in Germany.

BACKGROUND: A structural reform of the German psychotherapy guideline in 2017 was intended to facilitate access to outpatient guideline psychotherapy. In the present study, we evaluate the effects of this reform in particular for patients with a comorbidity of mental disorders and chronic physical conditions (cMP). METHODS: Pre-post analyses of the two primary endpoints "percentage of mentally ill persons who have made an initial contact with a psychotherapist" and "waiting time for guideline psychotherapy" were carried out employing population-based and weighted routine statutory health insurance data from the German BARMER. The secondary endpoints included evaluations from the patients' perspective, based on a representative survey of patients in psychotherapy, and an overview of the health care situation based on data from the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) (study registration number: DRKS00020344). RESULTS: From 2015 to 2018, the percentage of mentally ill persons who had made an initial contact with a psychotherapist rose moderately, from 3.7% (95% confidence interval, [3.6; 3.7]) to 3.9% [3.8; 3.9] among persons with cMP and from 7.3% [7.2; 7.4] to 7.6% [7.5; 7.7] among those with mental disorders but without any chronic physical condition (MnoP). The new structural elements were integrated into patient care. The interval of time between the initial contact and the beginning of guideline psychotherapy became longer in both groups, from a mean of 80.6 [79.4; 81.8] to 114.8 [113.4; 116.2] days among persons with complex disease and from 80.2 [79.2; 81.3] to 109.6 [108.4; 111.0] days among persons with non-complex disease; most patients considered the waiting time. Approximately 8% of the patients who sought psychotherapy reported that they had not obtained access to a psychotherapist. CONCLUSION: Neither in general nor for patients with cMP did the introduction of the structural reform appreciably lower the access barriers to psychotherapy. Further steps are needed so that outpatient care can meet the needs of all patients and particularly those with cMP.

The Agreement Between Diagnoses as Stated by Patients and Those Contained in Routine Health Insurance Data.

BACKGROUND: The frequency of medical diagnoses is a figure of central importance in epidemiology and health services research. Prevalence estimates vary depending on the underlying data. For a better understanding of such discrepancies, we compared patients' diagnoses as reported by themselves in response to our questioning with their diagnoses as stated in the routine data of their health insurance carrier. METHODS: For 6558 adults insured by BARMER, one of the statutory health insurance carriers in Germany, we compared the diagnoses of various illnesses over a twelve-month period, as reported by the patients themselves in response to our questioning (October to December 2021), with their ICD-10-based diagnosis codes (Q4/2020-Q3/2021). The degree of agreement was assessed with two kappa values, sensitivity, and specificity. RESULTS: The patients' stated diagnoses of diabetes and hypertension agreed well or very well with their diagnosis codes, with kappa and PABAK values near 0.8, as well as very high sensitivity and specificity. Moderately good agreement with respect to kappa was seen for the diagnoses of heart failure (0.4), obesity, anxiety disorder, depression, and coronary heart disease (0.5 each). The poorest agreement (kappa ≤ 0.3) was seen for posttraumatic stress disorder, alcohol-related disorder, and mental and somatoform disorder. Agreement was worse with increasing age. CONCLUSION: Diagnoses as stated by patients often differ from those found in routine health insurance data. Discrepancies that can be considered negligible were found for only two of the 11 diseases that we studied. Our investigation confirms that these two sources of data yield different estimates of prevalence. Age is a key factor; further reasons for the discrepancies should be investigated, and avoidable causes should be addressed.

[Potentially Inappropriate Medication of Nursing Home Residents: An Analysis of Risk Factors Based on National Claims Data (AOK) for 2017]. / Potentiell inadäquate Medikation bei Heimbewohnern: Eine Analyse von Risikofaktoren anhand bundesweiter GKV-Routinedaten der AOK für das Jahr 2017.

AIM OF THE STUDY: The aim of this study was to assess risk factors for prescription of potentially inappropriate medication (PIM) to nursing home residents using the PRISCUS list in 2017. METHODS: Using claims data (AOK) we analysed insured nursing home residents aged 65 or older in 2017. The PRISCUS list was used to identify PIMs. A multivariate logistic regression analysis was performed to analyse risk factors. RESULTS: The study population in 2017 included 259 328 nursing home residents, out of them 25.5% received at least one potentially inappropriate medication (women: 25.6%/men: 24.9%). Female and younger aged nursing home residents had a higher risk for at least one PRISCUS prescription. Polypharmacy, an increasing number of attending physicians, and hospital stays were additional risk factors for a PRISCUS prescription. Furthermore, regional (Bundesland) variations contributed to differences in PRISCUS prescriptions. CONCLUSION: The frequent PIM prescriptions in nursing home residents are a relevant topic regarding drug therapy safety. Regional differences, which cannot be explained by nursing home resident characteristics, show options for modifications and the need for further research.

Evaluating effects of the structural reform of outpatient psychotherapy for patients with mental disorders in Germany: comparing patients with and without comorbid chronic physical condition - rationale and study protocol of the ES-RiP project.

INTRODUCTION: In 2017, in Germany, a structural reform of the outpatient psychotherapy guideline took place, aiming to reduce waiting times, to facilitate flexible low-threshold access (eg, general reachability by phone) and to lower access barriers for specific patient groups. The reform included new service elements, such as the implementation of additional psychotherapeutic consultations, acute short-term psychotherapeutic interventions and relapse prophylaxis as well as the promotion of group therapies, the facilitation of psychotherapists' availability, and the installation of appointment service centres. The ES-RiP project aims to thoroughly evaluate the effects of the reform with a special focus on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs) compared with patients with a mental disorder but no long-term physical condition (MnoP). The project aims to evaluate (a) the extent to which the reform goals were achieved in the large group of patients with cMPs compared with MnoP, (b) the barriers that might hinder the implementation of the new guideline and (c) the procedures required for further developing and improving outpatient psychotherapy. METHODS AND ANALYSIS: A mixed-methods design (quantitative, qualitative) along with a multilevel approach (patients, service providers, payers) triangulating several data sources (primary and secondary data) will be applied to evaluate the reform from different perspectives. ETHICS AND DISSEMINATION: Ethical approval was obtained from the coordinating committee as well as one local ethics committee, Justus Liebig University Giessen and Marburg - Faculty of Medicine (approval number: AZ 107/20) and Heidelberg (approval number: S-466/2020). The results of this study will be disseminated through expert panels, conference presentations and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER: DRKS00020344.

[Prevalences of Depression Among Adults: Comparative Analysis of a Nationwide Survey and Routine Data]. / Prävalenzen von Depressionen bei Erwachsenen ­ eine vergleichende Analyse bundesweiter Survey- und Routinedaten.

AIM: There are differences in the prevalence estimates of depressive disorders based on primary and secondary data. The reasons for this are, for instance, the use of divergent indicators and varying observation periods. This study examines the prevalence of depressive disorders using survey and routine data for a comparable survey period and age range. Effects of differences between data sources and indicators are estimated. METHODS: For 2010, 3 indicators are compared: in a population survey collected a) self-reported medical diagnosis of depression, b) diagnosis of depressive disorders identified by clinical interviews and c) administrative depression diagnoses collected from routine data of a statutory health insurance. In sensitivity analyses, privately insured participants of the population survey were excluded, and insured persons with care needs were excluded from routine data. The definition of administrative depression diagnosis was varied depending on the frequency of coded diagnoses and the specificity of the diagnoses. RESULTS: The highest prevalence (9.8%) was found for depression diagnoses from administrative data, the lowest prevalence (5.9%) in self-reported medical diagnoses of depression in the population survey. The prevalence of depression identified by clinical interviews was 8.4%. Differing age and gender-related courses of illness were found. The administrative prevalence dropped significantly if unspecific diagnoses (F3x.8, F3x.9) were excluded. DISCUSSION: Depending on the definition of depression diagnoses used in administrative data, there was a reduction in differences of prevalence compared to the self-reported medical diagnoses. Differences in prevalence based on a diagnosis of a depressive disorder identified in a clinical interview remained stable, which indicates different groups of persons.

[Regional differences of ADHD diagnosis rates in health insurance data from 2005 to 2015 : Methodological considerations and results]. / Regionale Unterschiede von ADHS-Diagnoseraten in Krankenkassendaten 2005 bis 2015 : Methodische Überlegungen und Ergebnisse.

BACKGROUND AND OBJECTIVES: Attention deficit hyperactivity disorders (ADHD) are among the most common mental disorders in children and adolescents. For a number of years there has been evidence of regional differences in Germany. This article provides current results on the frequency of diagnosis and treatment and also discusses methodological aspects. MATERIALS AND METHODS: The analysis is based on routine data of a statutory health insurance company including annual diagnoses and drug prescriptions from 2005 to 2015 of at least 1.34 million children and adolescents between 0 and 19 years of age. Small-area results of ADHD diagnosis rates and methylphenidate prescriptions are presented with a standardized differentiation according to 413 districts pursuant to territorial status from the end of 2008. RESULTS: From 2005 to 2014, ADHD diagnoses were documented for an increasing proportion of 0 to 19-year-olds in Germany. In 2015 the proportion was 4.2%; boys aged 10 were affected most frequently with a proportion of 11.1%. Regional diagnosis rates vary considerably. Two counties showed diagnosis and prescription rates that were more than twice as high as regionally expected for all years in question; other districts showed rates that were continually lower than expected by at least a third. DISCUSSION: Analyses on the level of administratively defined districts have some advantages but alternative regional structuring would be desirable due to very heterogeneous population figures. Regarding ADHD diagnoses and documented methylphenidate prescriptions on an outpatient basis, significant regional differences in Germany were detected, for which plausible medical justifications do not yet exist. Specialist discussions seem urgently needed.

[Part-time Work and Men's Health : Results based on Routine Data of a Statutory Health Insurance Scheme]. / Teilzeitarbeit und Gesundheit von Männern : Ergebnisse auf der Basis von Routinedaten einer Krankenkasse.

BACKGROUND AND OBJECTIVES: With the introduction of a new occupational classification at the end of 2011, employment characteristics are reported by employees to social insurance agencies in Germany in more detail than in previous years. In addition to other changes, the new classification allows a distinction between full- and part-time work to be made. This provided a reason to consider the health-related aspects of part-time work on the basis of data from a statutory health insurance scheme. MATERIALS AND METHODS: Our analysis is based on the data of 3.8 million employees insured with the Techniker Krankenkasse (TK), a statutory health insurance scheme, in 2012. In addition to daily information on employment situations, details of periods and diagnoses of sick leave and the drugs prescribed were available. RESULTS: Although approximately 50 % of women of middle to higher working age worked part-time in 2012, the corresponding percentage of men employed in part-time work was less than 10 %. Overall, part-time employees were on sick leave for fewer days than full-time employees, but among men, sick leave due to mental disorders was longer for part-time employees than for full-time employees, whereas women working part time were affected to a lesser extent by corresponding periods of absence than those working full time. DISCUSSION: The results provide indications for the assertion that men in gender-specifically atypical employment situations are more frequently affected by mental disorders. Further evidence supports this assertion. With the long-term availability of these new employment characteristics, longitudinal analyses could help to clarify this cause-effect relationship.

[How often is the Depersonalization-Derealization Disorder (ICD-10: F48.1) diagnosed in the outpatient health-care service?]. / Wie oft wird die Depersonalisations-Derealisationsstörung (ICD-10: F48.1) in der ambulanten Versorgung diagnostiziert?

OBJECTIVES: The study determines how often Depersonalization-Derealization Disorder (ICD-10: F48.1) is diagnosed in the general population and analyzes the associations of other diseases with F48.1. METHODS: The sample consists of 1.567 million insured persons of a statutory health insurance fund in Germany. We analyzed the prevalence of F48.1 and the associations of F48.1 with other diseases according to ICD-10. RESULTS: We found a 1-year prevalence of 0.007 % for the diagnosis of F48.1. After adjustment for age, sex, depression and anxiety, several somatic disease groups were found to be associated with an increased likelihood of F48.1, e.g., abnormalities of breathing (R06), cardiac arrhythmias (I47-I49), epilepsy (G40), dizziness (H81, H82, R42) and headache (G43, G44, R51). CONCLUSIONS: According to epidemiological studies, the prevalence of depersonalization-derealization disorder is 1-2 %. We therefore conclude that F48.1 is severely underdiagnosed. Increased awareness for the detection of F48.1 and further health care research are urgently warranted.

Who is diagnosed as suffering from depression in the German statutory health care system? An analysis of health insurance data.

BACKGROUND: Depressive disease is becoming increasingly relevant in industrialised countries. For public health policy and planning it is important to know about the epidemiology of this disease as well as the extent to which this epidemiology impacts on health service provision. METHOD: Analysis of data from a major German statutory health insurance company: Longitudinal micro-level claims data containing information about diagnoses obtained from inpatient and outpatient sources as well as information collected from prescriptions issued for antidepressants. Data was analysed with regard to the differences in drug utilisation and the risk of being diagnosed with depression according to age, sex, marital status and area of residence. RESULTS: Results correspond significantly with the findings of population surveys on depression epidemiology. They also confirm the finding of a lower prevalence of depression in East Germany compared to West Germany. However, the claims data revealed an unexpectedly high prevalence of depression diagnosis in older age groups. CONCLUSION: Statutory health insurance data seems to be a reliable source of epidemiological information that is both easily accessible and longitudinally available, and thus provides important information that is needed for health policy and service planning. With regard to service provision it should be considered that depression in old age is a greater problem than is suggested by most epidemiological surveys.