Does one size really fit all? The effectiveness of a non-diagnosis-specific integrated mental health care program in Germany in a prospective, parallel-group controlled multi-centre trial

BMC Psychiatry

Research Article

Katrin Herder¹  Marina Julia Helmbrecht¹  Nadine Rosenfeld¹  Thomas Becker¹  Stefanie Prinz¹  Reinhold Kilian¹  Uemmueguelsuem Dinc¹  Annabel Sandra Mueller-Stierlin²  Matthias Schützwohl³  Marco Holzmann³  Julia Walendzik³ 

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

关键词: Integrated care;    Assertive community treatment;    Mental illness;    Empowerment;   

DOI  :  10.1186/s12888-017-1441-9

 received in 2017-04-06, accepted in 2017-07-24,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe Network for Mental Health (NWpG-IC) is an integrated mental health care program implemented in 2009 by cooperation between health insurance companies and community mental health providers in Germany. Meanwhile about 10,000 patients have been enrolled. This is the first study evaluating the effectiveness of the program in comparison to standard mental health care in Germany.MethodsIn a parallel-group controlled trial over 18 months conducted in five regions across Germany, a total of 260 patients enrolled in NWpG-IC and 251 patients in standard mental health care (TAU) were recruited between August 2013 and November 2014. The NWpG-IC patients had access to special services such as community-based multi-professional teams, case management, crisis intervention and family-oriented psychoeducation in addition to standard mental health care. The primary outcome empowerment (EPAS) and the secondary outcomes quality of life (WHO-QoL-BREF), satisfaction with psychiatric treatment (CSQ-8), psychosocial and clinical impairment (HoNOS) and information about mental health service needs (CAN) were measured four times at 6-month intervals. Linear mixed-effect regression models were used to estimate the main effects and interaction effects of treatment, time and primary diagnosis. Due to the non-randomised group assignment, propensity score adjustment was used to control the selection bias.ResultsNWpG-IC and TAU groups did not differ with respect to most primary and secondary outcomes in our participating patients who showed a broad spectrum of psychiatric diagnoses and illness severities. However, a significant improvement in terms of patients’ satisfaction with psychiatric care and their perception of treatment participation in favour of the NWpG-IC group was found.ConclusionsProviding integrated mental health care for unspecific mentally ill target groups increases treatment participation and service satisfaction but seems not suitable to enhance the overall outcomes of mental health care in Germany. The implementation of strategies for ameliorating the needs orientation of the NWpG-IC should be considered.Trial registrationGerman Clinical Trial Register DRKS00005111, registered 26 July 2013.

【 授权许可】

CC BY   
© The Author(s). 2017