Andreas Bechdolf1,2,3, Felix Bühling-Schindowski4, Konstantinos Nikolaidis4, Martin Kleinschmidt4, Stefan Weinmann5,6, Johanna Baumgardt4. 1. Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland. Andreas.Bechdolf@vivantes.de. 2. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln, Köln, Deutschland. Andreas.Bechdolf@vivantes.de. 3. ORYGEN, National Center of Excellence of Youth Mental, Health, University of Melbourne, Melbourne, Australien. Andreas.Bechdolf@vivantes.de. 4. Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban und Vivantes Klinikum im Friedrichshain - Akademische Lehrkrankenhäuser Charité-Universitätsmedizin Berlin, Dieffenbachstr. 1, 10967, Berlin, Deutschland. 5. Klinik für Psychiatrie und Psychotherapie, Rudolf-Sophien-Stift, Stuttgart, Deutschland. 6. Universitätsspital Basel, Basel, Schweiz.
Abstract
BACKGROUND: Based on international randomized controlled trials (RCT) the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) recommends acute treatment in the domestic environment (AHU) and intensive outreach treatment (IAB) with the highest level of evidence; however, due to large differences in national healthcare systems the transference of results from international studies to the healthcare systems in Germany, Austria and Switzerland could be limited. OBJECTIVE: Evaluation of studies on outreach psychiatric treatment forms in Germany, Austria and Switzerland and discussion of the results in the light of international evidence. MATERIAL AND METHODS: A systematic literature search for clinical trials on outreach community treatment from Germany, Austria and Switzerland was conducted in the PubMed database. RESULTS: A total of 19 publications were identified which could be assigned to 5 publications on 4 studies with 2857 patients on AHU and 14 publications on 10 studies with 3207 patients on IAB. The studies on AHU showed this treatment form to be superior regarding the duration of inpatient stay and healthcare costs. The studies on IAB showed more positive outcomes in comparison to controls regarding symptoms, severity of illness, substance abuse, functioning level, remission, satisfaction with treatment, quality of life, healthcare costs, work and housing situations. CONCLUSION: The studies from Germany, Austria, and Switzerland suggest that outreach community treatment is superior regarding several outcome parameters. Thus, there are no indications suggesting that international evidence could not be valid for these countries. Additionally, with one RCT for AHU and one for IAB the requirements for an evidence level of 1b for outreach community treatment in the healthcare systems in question are fulfilled.
BACKGROUND: Based on international randomized controlled trials (RCT) the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) recommends acute treatment in the domestic environment (AHU) and intensive outreach treatment (IAB) with the highest level of evidence; however, due to large differences in national healthcare systems the transference of results from international studies to the healthcare systems in Germany, Austria and Switzerland could be limited. OBJECTIVE: Evaluation of studies on outreach psychiatric treatment forms in Germany, Austria and Switzerland and discussion of the results in the light of international evidence. MATERIAL AND METHODS: A systematic literature search for clinical trials on outreach community treatment from Germany, Austria and Switzerland was conducted in the PubMed database. RESULTS: A total of 19 publications were identified which could be assigned to 5 publications on 4 studies with 2857 patients on AHU and 14 publications on 10 studies with 3207 patients on IAB. The studies on AHU showed this treatment form to be superior regarding the duration of inpatient stay and healthcare costs. The studies on IAB showed more positive outcomes in comparison to controls regarding symptoms, severity of illness, substance abuse, functioning level, remission, satisfaction with treatment, quality of life, healthcare costs, work and housing situations. CONCLUSION: The studies from Germany, Austria, and Switzerland suggest that outreach community treatment is superior regarding several outcome parameters. Thus, there are no indications suggesting that international evidence could not be valid for these countries. Additionally, with one RCT for AHU and one for IAB the requirements for an evidence level of 1b for outreach community treatment in the healthcare systems in question are fulfilled.
Keywords:
Assertive community treatment; Clinical trials; Crisis resolution; Home treatment; Inpatient equivalent treatment; Intensive case management; National health care system
Authors: Lise Estcourt; Simon Stanworth; Carolyn Doree; Sally Hopewell; Michael F Murphy; Alan Tinmouth; Nancy Heddle Journal: Cochrane Database Syst Rev Date: 2012-05-16
Authors: F Fischer; K Hoffmann; N Mönter; M Walle; R Beneke; S Negenborn; S Weinmann; S N Willich; A Berghöfer Journal: Gesundheitswesen Date: 2013-06-04
Authors: Johanna Baumgardt; Julian Schwarz; Sebastian Von Peter; Stefan Weinmann; Andreas Bechdolf; Konstantinos Nikolaidis; Martin Heinze; Johannes Hamann; Martin Holzke; Gerhard Längle; Janina Richter; Peter Brieger; Reinhold Kilian; Jürgen Timm; Constance Hirschmeier Journal: BMC Psychiatry Date: 2021-03-30 Impact factor: 3.630