德国的门诊心理治疗--结构改革评估。

IF 6.5 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Johannes Kruse, Hanna Kampling, Soufiane Filali Bouami, Thomas G Grobe, Mechthild Hartmann, Johanna Jedamzik, Ursula Marschall, Joachim Szecsenyi, Samuel Werner, Beate Wild, Sandra Zara, Gereon Heuft, Hans-Christoph Friederich
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引用次数: 0

摘要

背景:2017 年,德国对心理治疗指南进行了结构性改革,旨在促进门诊指南心理治疗的普及。在本研究中,我们评估了这一改革的效果,尤其是对精神障碍和慢性躯体疾病(cMP)合并症患者的影响:方法:利用德国 BARMER 的人口加权常规法定医疗保险数据,对 "与心理治疗师初次接触的精神病患者比例 "和 "指导性心理治疗的等待时间 "这两个主要终点进行了事前事后分析。次要终点包括基于心理治疗患者代表性调查的患者视角评估,以及基于全国法定医疗保险医生协会(Kassenärztliche Bundesvereinigung,KBV)数据的医疗状况概述(研究登记号:DRKS00020344):从2015年到2018年,与心理治疗师进行过初次接触的精神病患者比例适度上升,在患有精神障碍的患者中,从3.7%(95%置信区间,[3.6;3.7])上升至3.9% [3.8;3.9];在患有精神障碍但无任何慢性疾病(MnoP)的患者中,从7.3% [7.2;7.4] 上升至7.6% [7.5;7.7]。新的结构要素已融入病人护理中。两组患者从初次接触到开始接受指导性心理治疗的时间间隔都变长了,复杂疾病患者从平均 80.6 [79.4; 81.8] 天增加到 114.8 [113.4; 116.2] 天,非复杂疾病患者从 80.2 [79.2; 81.3] 天增加到 109.6 [108.4; 111.0]天;大多数患者都认为等待时间太长了。在寻求心理治疗的患者中,约有8%的人表示他们没有获得心理治疗师的帮助:结论:无论是对一般患者还是对 cMP 患者而言,结构改革的实施都没有明显降低心理治疗的障碍。还需要采取进一步措施,使门诊治疗能够满足所有患者,尤其是 cMP 患者的需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outpatient Psychotherapy in Germany—an Evaluation of the Structural Reform.

Background: A structural reform of the German psychotherapy guideline in 2017 was intended to facilitate access to outpatient guideline psychotherapy. In the present study, we evaluate the effects of this reform in particular for patients with a comorbidity of mental disorders and chronic physical conditions (cMP).

Methods: Pre-post analyses of the two primary endpoints "percentage of mentally ill persons who have made an initial contact with a psychotherapist" and "waiting time for guideline psychotherapy" were carried out employing population-based and weighted routine statutory health insurance data from the German BARMER. The secondary endpoints included evaluations from the patients' perspective, based on a representative survey of patients in psychotherapy, and an overview of the health care situation based on data from the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) (study registration number: DRKS00020344).

Results: From 2015 to 2018, the percentage of mentally ill persons who had made an initial contact with a psychotherapist rose moderately, from 3.7% (95% confidence interval, [3.6; 3.7]) to 3.9% [3.8; 3.9] among persons with cMP and from 7.3% [7.2; 7.4] to 7.6% [7.5; 7.7] among those with mental disorders but without any chronic physical condition (MnoP). The new structural elements were integrated into patient care. The interval of time between the initial contact and the beginning of guideline psychotherapy became longer in both groups, from a mean of 80.6 [79.4; 81.8] to 114.8 [113.4; 116.2] days among persons with complex disease and from 80.2 [79.2; 81.3] to 109.6 [108.4; 111.0] days among persons with non-complex disease; most patients considered the waiting time. Approximately 8% of the patients who sought psychotherapy reported that they had not obtained access to a psychotherapist.

Conclusion: Neither in general nor for patients with cMP did the introduction of the structural reform appreciably lower the access barriers to psychotherapy. Further steps are needed so that outpatient care can meet the needs of all patients and particularly those with cMP.

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来源期刊
Deutsches Arzteblatt international
Deutsches Arzteblatt international 医学-医学:内科
CiteScore
4.10
自引率
5.20%
发文量
306
审稿时长
4-8 weeks
期刊介绍: Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence. The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include: Carelit CINAHL (Cumulative Index to Nursing and Allied Health Literature) Compendex DOAJ (Directory of Open Access Journals) EMBASE (Excerpta Medica database) EMNursing GEOBASE (Geoscience & Environmental Data) HINARI (Health InterNetwork Access to Research Initiative) Index Copernicus Medline (MEDLARS Online) Medpilot PsycINFO (Psychological Information Database) Science Citation Index Expanded Scopus By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.
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