Effectiveness and efficiency of integrated mental health care programmes in Germany: study protocol of an observational controlled trial

BMC Psychiatry

Reinhold Kilian¹  Matthias Schützwohl²  Thomas Becker¹  Marco Holzmann²  Julia Walendzik²  Stefanie Prinz¹  Marina Julia Helmbrecht¹  Katrin Herder¹  Annabel Sandra Stierlin¹ 

[1] Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany;Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden, TU Dresden, Germany

关键词: Cost-effectiveness;    Empowerment;    Quality of life;    Schizophrenia;    Depression;    Mental illness;    Integrated care;   

Others  :  1123535
DOI  :  10.1186/1471-244X-14-163

 received in 2014-05-12, accepted in 2014-05-27,  发布年份 2014

【 摘 要 】

Background

Since 2009 some German health insurance companies have implemented integrated mental health care services along the principles of assertive community treatment in collaboration with local mental health service providers across Germany. Focus of this study is the analysis of effectiveness and cost-effectiveness of this integrated care programme compared to care as usual in routine care surroundings in five regions in Germany.

Methods

In this 18-month multi-centre observational trial 250 patients enrolled in an integrated mental health care programme and 250 patients who receive treatment as usual from five catchment areas will be included. In addition, in each group about 125 relatives of the participating patients will be included. The primary outcome criterion is the improvement of empowerment; secondary outcomes are subjective quality of life, functional impairment and costs of illness. Data will be collected at baseline and three follow-ups after 6, 12 and 18 months. Data will be analysed by means of mixed effects regression models. Propensity score methods are used for selection bias control.

Discussion

Study results are expected to provide information about how integrated care programmes in their present form contribute to the improvement of mental health care. In addition, the study will provide hints to weaknesses of the current integrated care programme and options to overcome them. The major strengths of this study are the real-world character of the study intervention with a simultaneous high level of academic rigour. However, the fact that patients are not randomised to study groups and that there is no blinding might limit the study.

Trial registration

German Clinical Trial Register DRKS00005111.

【 授权许可】

   
2014 Stierlin et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Stein LI, Santos AB: Assertive Community Treatment of Persons with Severe Mental Illness. 1st edition. New York: W.W. Norton; 1998.
• [2]Roberts E, Cumming J, Nelson K: A review of economic evaluations of community mental health care. Med Care Res Rev 2005, 62:503-543.
• [3]Latimer EA: Economic impacts of assertive community treatment: a review of the literature. Can J Psychiatry 1999, 44:443-454.
• [4]Rosen A, Mueser KT, Teesson M: Assertive community treatment–issues from scientific and clinical literature with implications for practice. J Rehabil Res Dev 2007, 44:813-825.
• [5]Knapp M, Beecham J, McDaid D, Matosevic T, Smith M: The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience. Health Soc Care Community 2011, 19:113-125.
• [6]Marshall M, Lockwood A: WITHDRAWN: Assertive community treatment for people with severe mental disorders. Cochrane Database Syst Rev 1998, Issue 2:CD001089. doi: 10.1002/14651858.CD001089
• [7]Dieterich M, Irving CB, Park B, Marshall M: Intensive case management for severe mental illness. Cochrane Database Syst Rev 2010, Issue 10:CD007906. doi: 10.1002/14651858. CD007906
• [8]Burns T, Catty J, Dash M, Roberts C, Lockwood A, Marshall M: Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. BMJ 2007, 335:336.
• [9]Karow A, Reimer J, König HH, Heider D, Bock T, Huber C, Schöttle D, Meister K, Rietschel L, Ohm G, Schulz H, Naber D, Schimmelmann BG, Lambert M: Cost-effectiveness of 12-month therapeutic assertive community treatment as part of integrated care versus standard care in patients with schizophrenia treated with quetiapine immediate release (ACCESS trial). J Clin Psychiatry 2012, 73:e402-8.
• [10]Lambert M, Bock T, Schöttle D, Golks D, Meister K, Rietschel L, Bussopulos A, Frieling M, Schödlbauer M, Burlon M, Huber CG, Ohm G, Pakrasi M, Chirazi-Stark MS, Naber D, Schimmelmann BG: Assertive community treatment as part of integrated care versus standard care: a 12-month trial in patients with first- and multiple-episode schizophrenia spectrum disorders treated with quetiapine immediate release (ACCESS trial). J Clin Psychiatry 2010, 71:1313-1323.
• [11]Fischer F, Hoffmann K, Mönter N, Walle M, Beneke R, Negenborn S, Weinmann S, Willich S, Berghöfer A: Kostenevaluation eines Modells der Integrierten Versorgung für schwer psychisch Kranke. Gesundheitswesen 2014, 76:86-95.
• [12]Steckermaier H: Integrierte Versorgung und Managed Care in der Gemeindepsychiatrie. Aufbau eines ambulanten Versorgungsnetzwerkes nach § 140a ff SGB V. In Masterarbeit. Hochschule München: Fakultät für angewandte Sozialwissenschaften; 2010.
• [13]Zechert C, Faulbaum-Decke W, Floeth T, Greuel M, Kleinschmidt M, Schädle J: Integrierte Versorgung in der Gemeindepsychiatrie - jetzt! Soziale Psychiatrie 2010, 127:4-9.
• [14]Kilian R, Becker T, Schleuning G, Welschehold M, Hertle C, Matschinger H, Hörand S: Die Entwicklung eines standardisierten Verfahrens zur Messung von Empowerment im Prozess der psychiatrischen Behandlung von Patienten mit schweren psychischen Erkrankungen. Ulm: Abschlussbericht Förderkennz. 101GX0743; 2012.
• [15]Andreas S, Harfst T, Dirmaier J, Kawski S, Koch U, Schulz H: A psychometric evaluation of the German version of the 'Health of the Nation Outcome Scales, HoNOS-D': on the feasibility and reliability of clinician-performed measurements of severity in patients with mental disorders. Psychopathology 2007, 40:116-125.
• [16]Kawski S, Andreas S, Harfst T, Dirmaier J, Koch U, Schulz H: Die “health of the nation outcome scales”: Entwicklung und erste psychometrische Analysen einer deutschen Version (HoNOS-D). Psychother Psych Med 2004, 54:AB49.
• [17]Wing J, Lelliott P, Beevor A, Trauer T, Slade M, Thornicroft G: HoNOS update. Br J Psychiatry 2000, 176:392-395.
• [18]McClelland R, Trimble P, Fox ML, Stevenson MR, Bell B: Validation of an outcome scale for use in adult psychiatric practice. Qual Health Care 2000, 9:98-105.
• [19]Angermeyer M, Kilian R, Matschinger H: WHOQOL-100 und WHOQOL-BREF: Handbuch für die deutschsprachigen Versionen der WHO-Instrumente zur internationalen Erfassung von Lebensqualität. Göttingen: Hogrefe Verlag; 2000.
• [20]Kilian R, Bernert S, Matschinger H, Mory C, Roick C, Angermeyer MC: Die standardisierte Erfassung des Behandlungs- und Unterstützungsbedarfs bei schweren psychischen Erkrankungen - Entwicklung und Erprobung der deutschsprachigen Version des Camberwell Assessment of Need-EU. Psychiatr Prax 2001, 28(Suppl 2):S79-83.
• [21]Phelan M, Slade M, Thornicroft G, Dunn G, Holloway F, Wykes T, Strathdee G, Loftus L, McCrone P, Hayward P: The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. Br J Psychiatry 1995, 167:589-595.
• [22]Attkisson CC, Zwick R: The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Program Plann 1982, 5:233-237.
• [23]Schmidt J, Lamprecht F, Wittmann WW: Zufriedenheit mit der stationären Versorgung. Entwicklung eines Fragebogens und erste Validitätsuntersuchungen. Psychother Psychosom Med Psychol 1989, 39:248-255.
• [24]Roick C, Kilian R, Matschinger H, Bernert S, Mory C, Angermeyer MC: Die deutsche Version des Client Sociodemographic and Service Receipt Inventory - Ein Instrument zur Erfassung psychiatrischer Versorgungskosten. Psychiatr Prax 2001, 28(Suppl 2):S84-90.
• [25]Brooks RG, Rabin R, de Charro F: The Measurement and Valuation of Health Status using EQ-5D: A European Perspective: Evidence from the EuroQol BIOMED Research Programme. Dordrchet, Boston: Kluwer Academic Pub; 2003.
• [26]Bernert S, Kilian R, Matschinger H, Mory C, Roick C, Angermeyer MC: Die Erfassung der Belastung der Angehörigen psychisch erkrankter Menschen - Die deutsche Version des Involvement Evaluation Questionnaires (IEQ-EU). Psychiatr Prax 2001, 28(Suppl 2):S97-101.
• [27]Frasch K, Weiser P, Becker T, Längle G, Steinert T, Niederreiner C, Pfiffner C, Jäger S, Bayer W, Eschweiler GW, Kilian R: Psychotropic drug treatment, clinical characteristics and cognitive processing speed in patients with schizophrenia: results from the ELAN study. Pharmacopsychiatry 2012, 45:138-145.
• [28]Längle G, Steinert T, Weiser P, Schepp W, Jaeger S, Pfiffner C, Frasch K, Eschweiler GW, Messer T, Croissant D, Becker T, Kilian R: Effects of polypharmacy on outcome in patients with schizophrenia in routine psychiatric treatment. Acta Psychiatr Scand 2012, 125:372-381.
• [29]Khandker SR, Koolwal GB, Samad HA: Handbook on Impact Evaluation: Quantitative Methods and Practices. Washington, D.C: World Bank; 2010.
• [30]Rubin DB: Multiple Imputation for Nonresponse in Surveys. Hoboken, NJ: Wiley-Interscience; 2004. [Wiley classics library]
• [31]Salize HJ, Kilian R: Gesundheitsökonomie in der Psychiatrie: Konzepte, Methoden, Analysen. 1st edition. Stuttgart: Kohlhammer; 2010. [Konzepte und Methoden der klinischen Psychiatrie]
• [32]Hoch JS, Rockx MA, Krahn AD: Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of "community acquired" syncope. BMC Health Serv Res 2006, 6:68. BioMed Central Full Text
• [33]Kilian R: Gesundheitsökonomische Evaluation in der psychiatrischen Versorgungsforschung. Präv Gesundheitsf 2008, 3:135-144.
• [34]Willan AR, Briggs AH, Hoch JS: Regression methods for covariate adjustment and subgroup analysis for non-censored cost-effectiveness data. Health Econ 2004, 13:461-475.