Evaluation of Flexible and Integrative Psychiatric Treatment Models in Germany - A Mixed-Method Patient and Staff-Oriented Exploratory Study

被引:24
作者
von Peter, Sebastian [1 ]
Ignatyev, Yuriy [1 ]
Johne, Jakob [2 ]
Indefrey, Sonja [2 ]
Kankaya, Onur Alp [2 ]
Rehr, Burkhard [1 ]
Zeipert, Manfred [1 ,2 ]
Bechdolf, Andreas [3 ]
Birkner, Thomas [4 ]
Deister, Arno [5 ]
Duve, Annette [6 ]
Rout, Sandeep [7 ]
Scherk, Harald [8 ]
Schulz-Dubois, Anna [9 ]
Wilms, Bettina [10 ]
Zedlick, Dyrk [11 ]
Grollich, Peter [1 ]
Braun, Bernard [12 ]
Timm, Jurgen [13 ]
Heinze, Martin [1 ]
机构
[1] Immanuel Klin Rudersdorf, Brandenburg Med Sch Theodor Fontane, Dept Psychiat & Psychotherapy, Rudersdorf, Germany
[2] Charite Univ Med Berlin, Dept Psychiat & Psychotherapy, Berlin, Germany
[3] Univ Cologne, Charite Univ Med Berlin, Vivantes Krankenhaus Urban, Dept Psychiat & Psychotherapy, Berlin, Germany
[4] Westklinikum Heide, Dept Psychiat Psychotherapy & Psychosomat Med, Heide, Germany
[5] Psychosoziales Zentrum Itzehoe, Itzehoe, Germany
[6] Vitos Klinikum Riedstadt, Dept Child & Adolescent Psychiat, Riedstadt, Germany
[7] Charite Univ Med Berlin, Vivantes Krankenhaus Neukoiln, Dept Psychiat & Psychotherapy, Berlin, Germany
[8] Vitos Klinikum Riedstadt, Dept Psychiat & Psychotherapy, Riedstadt, Germany
[9] Imland Krankenhaus Rendsburg, Dept Psychiat & Psychotherapy, Rendsburg, Germany
[10] Basedow Klinikum Saalekreis, Dept Psychiat & Psychotherapy, Querfurt, Germany
[11] Rudolf Virchow Krankenhaus Glauchau, Dept Psychiat & Psychotherapy, Glauchau, Germany
[12] Univ Bremen, SOCIUM Res Ctr, Bremen, Germany
[13] Univ Bremen, Competence Ctr Clin Trials, Biometry Sect, Bremen, Germany
关键词
implementation; cross sectoral mental health care; user evaluation; staff evaluation; mixed method; regional budget; block contract; capitation; MENTAL-HEALTH-CARE; ASSERTIVE COMMUNITY TREATMENT; CRISIS RESOLUTION TEAMS; REGIONAL BUDGET; SERVICES; PEOPLE; CONTINUITY; ILLNESS; IMPLEMENTATION; COMPONENTS;
D O I
10.3389/fpsyt.2018.00785
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Contrary to the practice in some countries, access to flexible and integrated forms of psychiatric care (FIT models) is limited in Germany. Several legislations have been introduced to improve this situation, notably the recent 64b (flexible and integrative treatment model; FIT64b) of the German Social Code, which allows for a capitation-based accounting of fees for services. The aim of this study was to explore the effects of FIT64b implementation on various stakeholders (patients, informal caregivers and staff) in 12 psychiatric hospital departments across Germany. Structural as well as quantitative and qualitative data are included, with integration of different methodological approaches. In all departments, the implementation of the new accounting system resulted into a relatively stable set of structural and processual changes where rigid forms of mainly inpatient care shifted to more flexible and integrated types of outpatient and outreach treatments. These changes were more likely to be perceived by patients and staff, and likewise received better evaluations, in those departments showing higher level or longer duration of implementation. Patients' evaluations, furthermore, were largely influenced by the advent of continuous forms of care, better accessibility, and by their degree of autonomy in steering of their services.
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页数:15
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