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Bramesfeld A. [Services for persons with mental illness in Germany from the perspective of the health and social system: current needs for development]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:363-370. [PMID: 36867192 PMCID: PMC10063473 DOI: 10.1007/s00103-023-03671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 03/04/2023]
Abstract
SUBJECT The article provides an overview on the current state of service provision for people with psychiatric illnesses, financed by health-insurance companies, the rehabilitation and participatory systems, and the German Federal States. Over the last 20 years, service capacities have continually improved. Three areas that are in need of further development are highlighted here: the coordination of services for mentally ill persons with complex needs; the long-term placement of persons with severe mental illness and challenging behavior; and a growing shortage of specialists. CONCLUSIONS The mental health system in Germany is largely well to very well developed. Despite this, specific groups do not benefit from the available assistance, and these often end up as "long-term patients" in psychiatric clinics. Models for coordinated and outpatient-oriented service provision for persons with severe mental illness exist, but are only sporadic. Intensive and complex outreach services in particular are lacking, as are service concepts that are able to cross the boundaries of social security responsibilities. The shortage of specialists, which affects the whole mental health system, requires restructuring toward a more outpatient-care focus. The first tools for this exist within the health insurance-financed system. They should be used.
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Affiliation(s)
- Anke Bramesfeld
- Institut für Epidemiologie Sozialmedizin und Gesundheitssystemforschung OE 5410, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Baum F, Schmitt J, Seifert M, Kliemt R, Kubat D, March S, Häckl D, Pfennig A, Swart E, Neumann A. Lengths of inpatient stay and sick leave of patients with mental diseases: disorder-specific effects of flexible and integrated treatment programs in Germany. Transl Psychiatry 2022; 12:370. [PMID: 36071050 PMCID: PMC9452681 DOI: 10.1038/s41398-022-02131-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
Mental disorders pose a worldwide growing public health burden. One of the major challenges for healthcare systems remains to respond to the need of patients with mental disorders for continuous and flexible treatment. The EVA64 study evaluates novel programs of flexible and integrative treatment (FIT) in hospitals. This manuscript presents results from the evaluation of FIT hospitals in comparison to hospitals from regular routine care. In addition to data from adult patients, we also present data from affiliated child and adolescent psychiatric wards employing FIT programs. Using comprehensive claims data, primary outcomes are the utilization of inpatient care and sick leave for a priori defined clusters of mental disorders. We stratify between patients already under treatment (ongoing treatment) and patients with incident treatment cases (initial treatment) at the point of inclusion in the study. In the initial treatment group, we found a significant reduction in the length of inpatient stay of 4.1 days in FIT hospitals compared to routine care. While patients with mood affective disorders (-1.8 days) and patients with neurotic, stress-related, and somatoform disorders (-3.6 days) showed an even stronger effect of the reduction of inpatient lengths of stay, the effect was significantly weaker in patients with mental and behavioral disorders due to use of alcohol (+3.3 days). Regarding the duration of sick leave, we found no significant treatment effect of FIT programs compared to routine care. In the ongoing treatment group of adult patients, we found a significantly lower utilization of inpatient treatment by 1.3 days as well as a shorter duration of sick leave by 4.3 days in FIT hospitals compared to routine care. In the cohort of children and adolescent patients, we also did not observe a significant treatment effect in either the initial treatment group or the ongoing treatment group. Registration: this study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713).
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Affiliation(s)
- Fabian Baum
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Jochen Schmitt
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Seifert
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Roman Kliemt
- WIG2 Scientific Institute for Health Economics and Health System Research Leipzig, Leipzig, Germany
| | - Denise Kubat
- Institute of Social Medicine and and Health Systems Research, Medical Faculty, Otto-von-Guericke- University Magdeburg, Magdeburg, Germany
| | - Stefanie March
- Institute of Social Medicine and and Health Systems Research, Medical Faculty, Otto-von-Guericke- University Magdeburg, Magdeburg, Germany
- Hochschule Magdeburg-Stendal, Department of Social Work, Health and Media, Magdeburg, Germany
| | - Dennis Häckl
- WIG2 Scientific Institute for Health Economics and Health System Research Leipzig, Leipzig, Germany
- Health Economics and Management, Faculty of Economics and Management Science, Leipzig University, Leipzig, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Enno Swart
- Institute of Social Medicine and and Health Systems Research, Medical Faculty, Otto-von-Guericke- University Magdeburg, Magdeburg, Germany
| | - Anne Neumann
- Center of Evidence-based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Schwarz J, Cechnicki A, Godyń J, Galbusera L, Biechowska D, Galińska-Skok B, Ciunczyk I, Ignatyev Y, Muehlensiepen F, Soltmann B, Timm J, von Peter S, Balicki M, Wciórka J, Heinze M. Flexible and Integrative Psychiatric Care Based on a Global Treatment Budget: Comparing the Implementation in Germany and Poland. Front Psychiatry 2022; 12:760276. [PMID: 35069275 PMCID: PMC8777040 DOI: 10.3389/fpsyt.2021.760276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany. Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared. Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition. Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Andrzej Cechnicki
- Community Psychiatry and Psychosis Research Centre, Jagiellonian University Medical College, Krakow, Poland
| | - Jan Godyń
- Psychosis Research Unit, Association for the Development of Community Psychiatry and Care, Krakow, Poland
| | - Laura Galbusera
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Daria Biechowska
- Department of Public Health, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Beata Galińska-Skok
- Department of Psychiatry, Medical University of Bialystok, Białystok, Poland
| | - Izabela Ciunczyk
- Middle Pomeranian Mental Health Centre “Medison”, Koszalin, Poland
| | - Yuriy Ignatyev
- Centre for Health Services Research Brandenburg, Brandenburg Medical School, Rüdersdorf, Germany
| | - Felix Muehlensiepen
- Centre for Health Services Research Brandenburg, Brandenburg Medical School, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Bettina Soltmann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Carl Gustav Carus University Hospital, Technical University Dresden, Dresden, Germany
| | - Jürgen Timm
- Biometry Section, Competence Centre for Clinical Trials, University of Bremen, Bremen, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
| | - Marek Balicki
- Pilot Program Office of the National Mental Health Program, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jacek Wciórka
- Pilot Program Office of the National Mental Health Program, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Martin Heinze
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany
- Centre for Health Services Research Brandenburg, Brandenburg Medical School, Rüdersdorf, Germany
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