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Integrierte Versorgung für erst- und mehrfacherkrankte Patienten mit schweren psychotischen Erkrankungen

3-Jahres-Ergebnisse des Hamburger Modells

Integrated care for patients with first and multiple episodes of severe psychotic illnesses

3-year results of the Hamburg model

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Hintergrund

Das „Hamburger Modell“ ist ein Integriertes Versorgungsmodell (IV) nach § 140 SGB V für Psychosebetroffene, welche die Kriterien für eine schwere psychische Erkrankung erfüllen.

Ziele der Arbeit

Darstellung des Behandlungsmodells und Evaluation der Effektivität für alle Patienten, die ≥3 Jahre in der IV behandelt werden.

Material und Methoden

Im Rahmen der Qualitätssicherungsstudie werden multidimensionale Daten zum Aufnahmestatus, zum Verlauf der Erkrankung und der Leistungen erfasst. Diese werden für alle 158 Patienten ausgewertet, die ≥3 Jahre in der IV behandelt werden.

Ergebnisse und Diskussion

Bei Aufnahme bildete sich die Schwere der Erkrankung u. a. durch hohe Psychopathologiewerte (BPRS: 80,3), hohe Krankheitsschwere (CGI-S/CGI-BP: 5,8), niedriges Funktionsniveau (GAF: 35,9) und die Häufigkeit von komorbiden psychischen (94,3 %) und somatischen (81,6 %) Erkrankungen ab. Lediglich 8 Patienten (5,1 %) brachen die Gesamtbehandlung ab. Im 3-Jahres-Verlauf kam es zu signifikanten und stabilen Verbesserungen in den Bereichen Psychopathologie (BPRS: p < 0,001), Krankheitsschwere (CGI-S/CGI-BP: p < 0,001), Funktionsniveau (GAF: p < 0,001), Lebensqualität (Q-LES-Q-18: p < 0,001) und Behandlungszufriedenheit (CSQ-8: 2,0 auf 3,3; p = 0,164; nicht signifikant, da große Verbesserungen zu Beginn). Zwangseinweisungen wurden reduziert und die medikamentöse Adhärenz sowie die Arbeitsfähigkeit verbessert (alle p < 0,001). Leistungsdaten zeigen kontinuierliche hochfrequente ambulante Behandlungskontakte (durchschnittlich 112,0 pro Jahr) mit einem hohen Anteil von Patienten in Psychotherapie (67 %) bei nahezu 90 %iger Reduktion jährlicher stationärer Behandlungstage von Jahr 1 zu Jahr 3. Durch integrierte Versorgung kann auch bei schwer erkrankten Psychosepatienten eine multidimensionale Verbesserung und Stabilisierung der Erkrankung erreicht werden.

Abstract

Background

The so-called "Hamburg model" is a designated integrated care model according to § 140 of the Social Code Book (SGB) V for psychosis patients fulfilling the definition of severe mental illness (SMI).

Objectives

Description of the model and evaluation of efficacy of all patients being treated for ≥ 3 years.

Materials and methods

Service entry illness status, course of illness, and interventions were assessed within a continuous quality assurance study. One hundred and fifty-eight patients who fulfilled the criterion of being treated for ≥ 3 years were analyzed.

Results

At service entry, SMI were among others mirrored by a high level of psychopathology (Brief Psychiatric Rating Scale [BPRS]: 80.3) and severity of illness (Clinical Global Impression Severity [CGI-S]/Clinical Global Impression Bipolar scales [CGI-BP]: 5.8), low functioning level (Global Assessment of Functioning scale [GAF]: 35.9), and high rates of comorbid psychiatric (94.3 %) and somatic (81.6 %) disorders. Only 8 patients (5.1 %) disengaged from the service within the 3-year treatment period. The course of the illness over 3 years showed significant and stable improvements in psychopathology (BPRS: p < 0.001), the severity of illness (CGI-S/CGI-BP: p < 0.001), functioning (GAF: p < 0.001), quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire [Q-LES-Q-18]: p < 0.001), and satisfaction with care (Client Satisfaction Questionnaire [CSQ-8]: 2.0 to 3.3; p = 0.164; nonsignificant because of early improvements). Further, compulsory admissions were reduced and medication adherence in addition to working ability improved (all p < 0.001). Data on interventions showed a continuously high frequency of outpatient interventions over time (on average 112.0 per year), a high percentage of patients in psychotherapy (67 %), and a nearly 90 % reduction in inpatient treatment days from year 1 to year 3.

Conclusion

Integrated care in severely ill patients with psychotic disorders leads to multidimensional illness improvement and stabilization by offering intensive outpatient care.

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Anerkennung der Mitarbeit (alphabetisch)

Prof. Dr. Thomas Bock, Fr. Dr. Alexandra Bussopulos, Anne Daubmann, Marietta Frieling, Dipl.-Psych. Stephan Glismann, Dipl.-Psych. Dietmar Golks, Heiner Hasslöwer, Prof. Dr. Dr. Martin Härter, Dipl.-Psych. Andrea Kerstan, Prof. Dr. Hans-Helmut König, Benjamin Lange, Matthias Lange, Fr. Dr. Christina Meigel-Schleiff, Luise Nawara, Susanne Quante, Dipl.-Psych. Liz Rietschel, Dr. Michael Schödlbauer, Dipl.-Psych. Mary Sengutta, Prof. Dr. Klaus Wiedemann, Dipl.-Psych. Linus Wittmann.

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Correspondence to Martin Lambert.

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Interessenkonflikt

D. Schöttle, F. Ruppelt, D. Lüdecke, G. Sarikaya, M. Schulte-Markwort, J. Gallinat, A. Karow geben an, dass kein Interessenkonflikt besteht.

Interessenkonflikte von Prof. Dr. Martin Lambert

Finanzielle Verbindungen zu Unternehmen:

Keine

Beschäftigungsverhältnisse:

Keine

Beratungstätigkeit:

AstraZeneca, Lilly Deutschland GmbH, Janssen Cilag GmbH, Roche Deutschland Holding GmbH, Trommsdorff GmbH & Co. KG

Aktienbesitz:

Keine

Honorare für Vorträge

AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH, Roche Deutschland Holding GmbH, Sanovi Aventis

Reisekostenübernahmen:

AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH, Roche Deutschland Holding GmbH, Sanovi Aventis, Trommsdorff GmbH & Co. KG

Studienunterstützungen:

AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck, Sanovi Aventis

Verbindungen zu Krankenkassen

Integrierte Versorgungsverträge nach § 140 SGB V mit DAK Gesundheit, AOK Rheinland/Hamburg, HEK, IKK Classic

Nichtmaterielle Interessenskonflikte:

Keine

Interessenkonflikte von Dr. Daniel Schöttle

Finanzielle Verbindungen zu Unternehmen:

Keine

Beschäftigungsverhältnisse:

Keine

Beratungstätigkeit:

Janssen Cilag GmbH, Otsuka Pharma GmbH

Aktienbesitz:

Keine

Honorare für Vorträge:

AstraZeneca, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH,

Reisekostenübernahmen:

Keine

Studienunterstützungen:

AstraZeneca

Verbindungen zu Krankenkassen:

Integrierte Versorgungsverträge nach § 140 SGB V mit DAK Gesundheit, AOK Rheinland/Hamburg, HEK, IKK Classic

Nicht-materielle Interessenskonflikte:

Keine

Interessenkonflikte von Friedrike Ruppelt

Friedrike Ruppelt:

Keine

Interessenkonflikte von Daniel Lüdecke

Daniel Lüdecke:

Keine

Interessenkonflikte von Gizem Sarikaya

Gizem Sarikaya:

Keine

Interessenkonflikte von Prof. Dr. Michael Schulte-Markwort

Finanzielle Verbindungen zu Unternehmen:

Keine

Beratungstätigkeit:

Lilly Deutschland GmbH, Philips International

Aktienbesitz:

Keine

Honorare für Vorträge:

Actelion GmbH, Bristol-Myers Squibb, Lilly Deutschland GmbH, Otsuka Pharma GmbH

Reisekostenübernahmen:

Keine

Studienunterstützungen:

Philips Deutschland

Verbindungen zu Krankenkassen:

Keine

Nicht-materielle Interessenskonflikte:

Keine

Interessenkonflikte von Prof. Dr. Jürgen Gallinat

Finanzielle Verbindungen zu Unternehmen:

Keine

Beschäftigungsverhältnisse:

Keine

Beratungstätigkeit:

Keine

Beratungstätigkeit:

Keine

Aktienbesitz:

Keine

Honorare für Vorträge:

AstraZeneca, Janssen-Cilag, und Bristol-Myers Squibb

Reisekostenübernahmen:

Keine

Studienunterstützungen:

AstraZeneca, Eli Lilly & Co, Janssen-Cilag, Bristol-Myers Squibb

Verbindungen zu Krankenkassen:

Keine

Nicht-materielle Interessenskonflikte:

Keine

Interessenkonflikte von PD Dr. Anne Karow

Finanzielle Verbindungen zu Unternehmen:

Keine

Beschäftigungsverhältnisse:

Keine

Beratungstätigkeit:

AstraZeneca

Aktienbesitz:

Keine

Honorare für Vorträge:

AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH, Roche Deutschland Holding GmbH

Reisekostenübernahmen:

AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH, Roche Deutschland Holding GmbH, Sanovi

Studienunterstützungen:

AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH

Verbindungen zu Krankenkassen:

Integrierte Versorgungsverträge nach § 140 SGB V mit DAK Gesundheit, AOK Rheinland/Hamburg, HEK, IKK Classic

Nicht-materielle Interessenskonflikte:

Keine

Über psychenet

„psychenet – Hamburger Netz psychische Gesundheit“ ist ein vom Bundesministerium für Bildung und Forschung (BMBF) von 2011 bis 2014 gefördertes Projekt, mit dem die Stadt Hamburg 2010 den Titel „Gesundheitsregion der Zukunft“ erhalten hat. Ziel des Projektes ist es, heute und in Zukunft psychische Gesundheit zu fördern, psychische Erkrankungen früh zu erkennen und nachhaltig zu behandeln. Die Koordination des Verbundes übernimmt die Gesundheitswirtschaft Hamburg GmbH gemeinsam mit dem Universitätsklinikum Hamburg-Eppendorf.

Weitere Informationen sowie eine Liste aller Projektpartner unter www.psychenet.de.

Kontakt

Andreas Brandes | Gesundheitswirtschaft Hamburg GmbH | c/o Handelskammer Hamburg | Adolphsplatz 1 | 20457 Hamburg | Tel.: 040/361 38 9403 | Fax: 040/361 38 9409 | E-Mail: andreas.brandes@gwhh.de

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Lambert, M., Schöttle, D., Ruppelt, F. et al. Integrierte Versorgung für erst- und mehrfacherkrankte Patienten mit schweren psychotischen Erkrankungen. Bundesgesundheitsbl. 58, 408–419 (2015). https://doi.org/10.1007/s00103-015-2123-8

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