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 trialReportar como inadecuado




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BMC Psychiatry

, 17:283

Social psychiatry, therapy and provision of mental health care

Abstract

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.

KeywordsIntegrated care Assertive community treatment Mental illness Empowerment AbbreviationsCANCamberwell Assessment of Needs

CRTCrisis Resolution Team

CSQ-8German Version of the Client Satisfaction Questionnaire

CSSRIClient Socio-Demographic and Service Receipt Inventory

EPASQuestionnaire for the assessment of empowerment in patients with affective and schizophrenic disorders

HoNOSHealth of the Nation Outcome Scale

HTHome treatment

ICIntegrated care

ICMIntensive Case Management

NWpC-ICIntegrated care according to NWpG

NWpG Netzwerk für psychische Gesundheit - Network for Mental Health

OROdds ratio

sdStandard deviation

SMISevere mental illness

TAUTreatment as usual

WHO-QoL-BREFShort version of the World Health Organisation Quality of Life questionnaire

Electronic supplementary materialThe online version of this article doi:10.1186-s12888-017-1441-9 contains supplementary material, which is available to authorized users.

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Autor: Annabel Sandra Mueller-Stierlin - Marina Julia Helmbrecht - Katrin Herder - Stefanie Prinz - Nadine Rosenfeld - Julia Wale

Fuente: https://link.springer.com/







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