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Kruse J, Kampling H, Bouami SF, Grobe TG, Hartmann M, Jedamzik J, Marschall U, Szecsenyi J, Werner S, Wild B, Zara S, Heuft G, Friederich HC. Outpatient Psychotherapy in Germany—an Evaluation of the Structural Reform. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:315-322. [PMID: 38544323 PMCID: PMC11413774 DOI: 10.3238/arztebl.m2024.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 07/09/2024]
Abstract
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.
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Affiliation(s)
- Johannes Kruse
- These two authors are co-first authors
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
| | - Hanna Kampling
- These two authors are co-first authors
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Soufiane Filali Bouami
- aQua – Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany
| | - Thomas G. Grobe
- aQua – Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Johanna Jedamzik
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Institute for Health System Research, Wuppertal, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Samuel Werner
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sandra Zara
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Gereon Heuft
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Jedamzik J, Kampling H, Christoffer A, Szardenings C, Heuft G, Friederich HC, Kruse J. Do the elderly and those with comorbid chronic physical conditions have improved access to outpatient psychotherapy post structural reforms in Germany? Results of the ES-RiP study. Front Psychiatry 2024; 15:1349603. [PMID: 38742126 PMCID: PMC11090099 DOI: 10.3389/fpsyt.2024.1349603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Background In 2017, a reform of the German outpatient psychotherapy guideline was carried out, aiming to reduce waiting times and facilitate low-threshold access. This study analyzes the extent to which the implementation of the two new service elements 'psychotherapeutic consultation times' and 'acute short-term psychotherapeutic interventions' improved psychotherapeutic care for patients with mental disorders and chronic physical conditions (cMPs), for patients with mental disorders without chronic physical conditions (MnoP), and elderly patients. Methods In a quantitative secondary analysis, we analyzed health insurance data of patients with psychotherapy billing codes obtained from the National Association of Statutory Health Insurance Physicians (KBV) for the years 2015-2019, evaluating descriptive statistical parameters for specific patient groups and care services. Results Between 2015 and 2019, the number of mentally ill receiving psychotherapy at least once in the corresponding year increased by 30.7%. Among these, the proportion of cMPs-patients increased from 26.8% to 28.2% (+1.4%), while that of MnoP-patients decreased from 68.3% to 66.4% (-1.9%). The number of elderly people receiving treatment also increased. Conclusion Since increases and decreases in the percentage shares occur evenly over the years investigated, it is questionable whether the reform in 2017 has had a direct influence on these changes. Study registration ID DRKS00020344, URL: https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html.
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Affiliation(s)
- Johanna Jedamzik
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Andrea Christoffer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Carsten Szardenings
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Gereon Heuft
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
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Lech S, Herrmann W, Trautmann S, Schwantes U, Gellert P, Behr J, Buspavanich P. Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany. BMC Health Serv Res 2022; 22:1279. [PMID: 36280876 PMCID: PMC9594952 DOI: 10.1186/s12913-022-08631-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/30/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Depression is the most common mental health burden worldwide. Primary care physicians (PCPs) play a key role in the care provision for people with depression. The first objective of the present study was to examine the health care situation of depression in primary care, focusing on the cooperation between PCPs and mental health specialists. Secondly, we aimed at examining the role of the German S3 Guideline for Unipolar Depression in the primary care provision. METHODS Data of N = 75 PCPs were analysed from a cross-sectional online survey. Analysis of descriptive information on the current status of primary health care and depression was conducted. Further, to examine factors that are related to the usage of guidelines, multiple regression was performed. RESULTS Only 22.1% of PCPs described the quality of cooperation with ambulatory mental health specialist as good. The most frequent problems in the cooperation were of structural nature (49.3%, long waiting list, few therapy units, as well as barriers in the communication and the information exchange). With regard to the role of the guideline, 65% of PCPs reported never or seldom using the guideline and 31.7% of PCPs perceived the guideline as not useful at all. In addition, perceived usefulness of the S3 guideline was positively associated with the usage of the guideline. Results of the logistic regression revealed a significant association between the usage of the German S3 Guideline for Unipolar Depression and rating of perceived usefulness of the guideline (OR: 4.771; 95% CI: 2.15-10.59; p < 0.001). CONCLUSION This study highlights the central role of PCPs and demonstrates major barriers in the outpatient health care provision of depression. Present findings suggest a strong need for collaborative health care models to resolve obstacles resulting from fragmented mental health care systems. Finally, reported perceived barriers in the implementation of the German S3 Guideline for Unipolar Depression indicate the urge to involve PCPs in the development of evidence-based guidelines, in order to ensure a successful implementation and usage of guidelines in clinical practice.
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Affiliation(s)
- Sonia Lech
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Wolfram Herrmann
- Institute of General Practice, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Trautmann
- ICPP Institute of Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany
- Department of Psychology, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | | | - Paul Gellert
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim Behr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany
- Research Department of Experimental and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pichit Buspavanich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany
- Department of Psychiatry and Psychotherapy, Gender Research in Medicine & Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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