Prevention of rehospitalization in schizophrenia: results of an integrated care project in Germany

  • Christian Schmidt-Kraepelin
  • Birgit Janssen
  • Wolfgang Gaebel
Article

Abstract

The goal of this study was to prevent rehospitalizations and thus to optimize satisfaction with treatment and quality of life in patients suffering by schizophrenia or schizoaffective disorder. A complex intervention with improved cooperation between in- and outpatient services was applied to 46 “high utilizing” patients after discharge from inpatient care during an intervention phase of 6 months. The study was controlled by a matched group of 47 patients receiving treatment as usual. The intervention was based on a computerized decision support module. Eight psychiatrists in private practices were supplied with this software to obtain guideline-based recommendations according to current psychopathology and clinical state. Suggested complex interventions by the software included psychoeducation, social competence group therapy, integrated psychological therapy, computer-based cognitive training, coping skills training, sociotherapy, nursing care, home visits, social-worker care, assistance to family members, and the use of an emergency call-in line. A local hospital project team arranged specifically suggested interventions. We intended to accomplish a reduction of rehospitalization rates by 50% in the intervention group within a 12-month follow-up phase. Satisfaction with treatment, subjective quality of life, and treatment costs in terms of daily inpatient costs were compared between both groups. Moderator variables such as socio-demographical aspects or influences of certain interventions to rehospitalization rate were analyzed. The sample included patients more seriously ill than originally expected. Subjects in the control group (CG) were older (46 years) than those subjects in the intervention group (IG) (40 years). Other sociodemographical aspects (sex, family status, level of education, and number of former hospitalizations) showed no differences between both groups. The rehospitalization rate and the mean length of inpatient treatment were reduced to nearly 50% in the intervention group. The rate of readmissions increased in the control group, leading to a difference of 23% between both groups. The most important factor to favorably influence rehospitalization rates was the participation in coping skills training. There was an increase in patient satisfaction with treatment, while the subjective quality of life remained constant. Since these improvements were accomplished with lower costs (in terms of inpatient care), cost effectiveness was higher in the IG than in the CG. The most important single factor to favorably influence rehospitalization rates was the participation in coping skills training. Only the guideline consistent complex therapies as common intervention caused the significant overall result. Thereby, satisfaction with treatment increased considerably during the 6 months of intervention and remained constant during 12 months of follow up. The model project described is an important step to gain evidence and experience with integrated care for patients with schizophrenia.

Keywords

Integrated care Complex interventions Schizophrenia Outpatient treatment Clinical guidelines 

References

  1. 1.
    Albus M, Burkes S, Scherer J (1995) Welche Faktoren beeinflussen die Medikamenten-Compliance? Psychiat Prax 22:228–230Google Scholar
  2. 2.
    Bender S, Dittmann-Balcar A, Prehn G et al (2004) Subjektives Erleben eines computergestützten kognitiven Trainings durch Patienten mit Schizophrenien. Nervenarzt 75:44–50CrossRefPubMedGoogle Scholar
  3. 3.
    Berger M (2004) Engagement der DGPPN zur Etablierung von integrierten Versorgungsnetzen für psychische Erkrankungen. http://www.dgppn.de/stellungnahmen/2004
  4. 4.
    Blaeser-Kiel G (2003) Schizophrenie -Integrative Konzepte auf allen Ebenen erforderlich. Dtsch Ärztebl 6:265–266Google Scholar
  5. 5.
    Brenner HD, Roder V, Kienzle N et al (1997) Integriertes Psychologisches Therapieprogramm für schizophrene Patienten. Psychologie Verlags Union, Beltz, WeinheimGoogle Scholar
  6. 6.
    Brown AH, Cohen AN, Chinman MJ, Kessler C, Young AS (2008) EQUIP: Implementing chronic care principles and applying formative evaluation methods to improve care for schizophrenia: QUERI Series. Implement Sci 15;3:9Google Scholar
  7. 7.
    Clade H (2004) Schizophrenie. Ein kostenträchtiges Krankheitsbild. Dtsch Ärztebl 101(47):3160Google Scholar
  8. 8.
    DGPPN (Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde) (2005) S3—Praxisleitlinie Schizophrenie der DGPPN. http://www.dgppn.de/leitlinien/projektgruppe/S3_Stand2005-09-28.doc
  9. 9.
    DGPPN (Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde) (1997) Die Behandlung psychischer Erkrankungen in Deutschland. Positionspapier zur Aktuellen Lage und zukünftigen Entwicklung. Springer, BerlinGoogle Scholar
  10. 10.
    Emsley R, Chiliza B, Schoeman R (2008) Predictors of long-term outcome in schizophrenia. Curr Opin Psychiatry 21(2):173–177CrossRefPubMedGoogle Scholar
  11. 11.
    Frieboes R-M (2003) Soziotherapie gemäß § 37a SGB V, Psychiatrische Indikation, Leistungsbeschreibung und sozialrechtlicher Hintergrund. Nervenarzt 74:596–600CrossRefPubMedGoogle Scholar
  12. 12.
    Gaebel W (2002) Schizophrenie, schizotype und wahnhafte Störungen. In: Gaebel W, Müller-Spahn F (eds) Diagnostik und Therapie psychischer Störungen. Kohlhammer, StuttgartGoogle Scholar
  13. 13.
    Häfner H, an der Heiden W (1997) Epidemiology of schizophrenia. Can J Psychiatry 42, Bd. 2:193–151Google Scholar
  14. 14.
    Hinsch R, Pfingsten O (1998) Gruppentraining sozialer Kompetenzen, 3rd edn. Psychologie Verlags Union, WeinheimGoogle Scholar
  15. 15.
    Janssen B, Menke R, Pourhassan F et al (2005) Leitlinienimplementierung auf der Basis eines computergestützten decision-support-Systems, Ein Beitrag zum Qualitätsmanagement in der ambulanten nervenärztlichen Schizophreniebehandlung. Nervenarzt 77:567–575CrossRefGoogle Scholar
  16. 16.
    Kallert W, Leisse M, Winiecki P (2004) Needs for care of chronic schizophrenic patients in long-term community treatment. Soc Psychiatr Epidemiol 39:386–396CrossRefGoogle Scholar
  17. 17.
    Kassenärztliche Bundesvereinigung (2000) Rahmenvereinigung zur integrierten Versorgung gemäß § 140 d SGB V. Deutsches Ärzteblatt 2000, 49Google Scholar
  18. 18.
    Klingberg S, Schaub A, Conradt B (2003) Rezidivprophylaxe bei schizophrenen Störungen. Beltz, BerlinGoogle Scholar
  19. 19.
    Lehman AF, Steinwachs DM (2003) Evidence-based psychosocial treatment practices in schizophrenia: lessons from the patient outcomes research team (PORT) project. J Am Acad Psychoanal Dyn Psychiatry 31(1):141–154CrossRefPubMedGoogle Scholar
  20. 20.
    Lincoln T (2006) Kognitive Verhaltentherapie der Schizophrenie. Ein individuenzentrierter Ansatz zur Veränderung von Wahn, Halluzinationen und Negativsymptomatik. Hogrefe, GöttingenGoogle Scholar
  21. 21.
    Lora A, Cosentino U, Gandini A, Zocchetti C (2007) Which community care for patients with schizophrenic disorders? Packages of care provided by Departments of Mental Health in Lombardy (Italy). Epidemiol Psichiatr Soc 16(4):330–338PubMedGoogle Scholar
  22. 22.
    Malm U, Ivarsson B, Allebeck P, Falloon IRH (2003) Integrated care in schizophrenia: a 2-year randomized controlled study of two community-based treatment programs. Acta Psychiatr Scand 107:415–442CrossRefPubMedGoogle Scholar
  23. 23.
    Marker KR (1999) Handbuch zum Programmpaket Cogpack. Version 5.9j Janssen-Cilag, marker software, LadenburgGoogle Scholar
  24. 24.
    Müller DR, Roder V, Brenner HD (2005) Effektivität des Integrierten Psychologischen Therapieprogramms für schizophren Erkrankte—Eine Metaanalyse über 28 unabhängige Studien. Nervenarzt, Springer, Berlin HeidelbergGoogle Scholar
  25. 25.
    Priebe S, Hoffmann C, Kaiser W, Roeder-Wanner UU (1993) BELP Berliner Lebensqualitätsprofil. unpublished manuscript, BerlinGoogle Scholar
  26. 26.
    Rössler W, Theodoridou A (2006) [Innovative care models for treating psychosis] Nervenarzt 77(Suppl 2):S111–118; quiz S119. GermanGoogle Scholar
  27. 27.
    Sozialgesetzbuch Fünftes Buch (2004) Anschubfinanzierung, Bereinigung, § 140dGoogle Scholar
  28. 28.
    Schmidt J, Lambrecht F, Wittmann WW (1989) Fragenbogen zur Zufriedenheit mit der stationären Versorgung. Psychother Psychosom Med Psychol 39:248–255PubMedGoogle Scholar
  29. 29.
    Semisa D, Casacchia M, Di Munzio W, Neri G, Buscaglia G, Burti L, Pucci C, Corlito G, Bacigalupi M, Parravani R, Roncone R, Cristofalo D, Lora A, Ruggeri M; Gruppo SIEP-DIRECT’S (2008) [Promoting recovery of schizophrenic patients: discrepancy between routine practice and evidence. The SIEP-DIRECT’S Project]. Epidemiol Psichiatr Soc 17(4):331–348. ItalianGoogle Scholar
  30. 30.
    Weinmann S, Gaebel W (2005) Versorgungserfordernisse bei schweren psychischen Erkrankungen, Wissenschaftliche Evidenz zur Integration von klinischer Psychiatrie und Gemeindepsychiatrie. Nervenarzt 76(7):809CrossRefPubMedGoogle Scholar
  31. 31.
    Wölwer W, Buchkremer G, Häfner H et al (2003) German research network on schizophrenia. Bridging the gap between research and care. Eur Arch Psychiatry Clin Neurosci 253:312–329CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Christian Schmidt-Kraepelin
    • 1
  • Birgit Janssen
    • 1
  • Wolfgang Gaebel
    • 1
  1. 1.LVR-Klinikum Düsseldorf, Department of Psychiatry and PsychotherapyHeinrich-Heine-University DüsseldorfDüsseldorfGermany

Personalised recommendations