Collaborative mental health care program versus a general practitioner program and usual care for treatment of patients with mental or neurological disorders in Germany: protocol of a multiperspective evaluation study

Abstract

BackgroundGerman statutory health insurances are pursuing the goal of improving treatment of chronically ill people by promoting networks of health care providers and supporting treatments that reflect the current medical knowledge. The so-called PNP program is a collaborative care program developed by a German statutory health insurance, which defines specific rules on psychiatric, neurological, psychosomatic, and psychotherapeutic treatment. It aims to strengthen provision of guideline-based outpatient treatment and collaboration between different health care providers. It includes the general practitioners’ program, which aims to strengthen the coordinating role of GPs. This study aims to evaluate the PNP program.MethodsTo evaluate the effectiveness of the PNP program, we will conduct a prospective non-randomized controlled trial with primary data comparing patients enrolled in the PNP program and in the general practitioner program (intervention group) to patients enrolled only in the general practitioner program and patients who receive usual care (control groups). To evaluate costs and level of detail of diagnoses in care of patients with PNP program, we will use routinely collected secondary administrative health data in a retrospective quasi-experimental design. Patients who are at least 18 years old, insured by the statutory health insurance AOK, and on sick leave due to one of the mental or neurological diagnoses (affective, anxiety, somatoform or adjustment disorders, alcohol use disorders, schizophrenia, multiple sclerosis) will be included. We will collect data at baseline and at 12-months follow-up. Health-related quality of life (primary data) and direct costs (secondary data) caused by outpatient and inpatient service utilization and medication will be the primary outcomes. We will analyze data using (generalized) linear mixed models and exploratory analyses. We will use entropy balancing to control for possible differences between the groups. We will use an exploratory sequential design including qualitative and descriptive statistical analyses to assess the structure and process quality of the PNP program among health care providers.DiscussionThe results will help to develop a comprehensive picture of collaborative care programs for mental and neurological health care from the perspective of patients, health care providers, and health insurance companies.Trial registrationGerman Clinical Trial Register DRKS00013114Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1914-5) contains supplementary material, which is available to authorized users.

Effectiveness of a multimodal training programme to improve general practitioners’ burnout, job satisfaction and psychological well-being

“…In relation to government of mental-health patients indicators, first, analysing the indicated improvements on our administrative health data offered by the MTP, it is difficult to draw clear conclusions when comparing our results with related surveys, given the disparity of samples, health-system structures, etc. [27]. The achievements shown by the EG in accessibility and in total annual visits by each GP for all pathologies (inter-group evolution differences) might be interpreted as case-management improvements, although our study design did not allow us to draw strong conclusions or to elucidate alternative explanations.…”

“…In this context, Collaborative Care Models (CCMs) offers a framework in which related disciplines can be combined, consequently allowing for an evaluation of their respective interventions. CCMs are team-based, multicomponent interventions that have been shown to be cost-efficient in improving mental and physical outcomes for a range of mental-health conditions across diverse populations and primary-care settings [27, 28]. To our knowledge, CCM methodology has never been tested on the burnout, job satisfaction and psychological well-being of GPs rather than that of patients.…”

PNP-Vertrag – Facharztvertrag Psychotherapie, Neurologie, Psychiatrie in Baden-Württemberg: Evaluation aus der Sicht der teilnehmenden Behandlerinnen und Behandler

“…Insgesamt deuten die Ergebnisse darauf hin, dass einige der Betroffenen mit depressiven und Angststörungen benannte Versorgungsbarrieren der Regelversorgung, wie die späte Diagnosestellung und der späte Therapiebeginn [27], durch den Vertrag reduziert werden können. Inwieweit die durch die Behandelnden eingeschätzten Verbesserungen auch die Patientinnen und Patienten erreichen, werden durch die folgenden Effektivitäts-und Sekundärdatenanalysen [28] untersucht [19]. ▶ Tab.…”

“…"Collaborative Care") zwischen haus-und fachärztlicher Versorgung eine wichtige Rolle [16][17][18]. Der seit 2012 bestehende Selektivvertrag zur Versorgung in den Fachgebieten der Neurologie, Psychiatrie, Psychosomatik und Psychotherapie (PNP-Vertrag) gemäß § 73c SGB V der AOK Baden-Württemberg (AOK BW) orientiert sich an den Collaborative-Care-Ansätzen [19]. Er wurde gemeinsam mit Vertragspartnern entwickelt und flächendeckend in Baden-Württemberg implementiert.…”

“…Im Mittelpunkt des PNP-Vertrags steht eine von Fachärztinnen und -ärzten (FÄ) und Psychotherapeutinnen und -therapeuten (PT) in Verbindung mit Hausärztinnen und -ärzten (HÄ) gemeinsam koordinierte, evidenzbasierte Behandlung auf Grundlage einer rechtzeitigen und spezifischen Diagnosestellung (vgl. [19]). Der PNP-Vertrag hat das Ziel, die Gesundheitsversorgung von Menschen mit psychischen und neurologischen Erkrankungen durch eine neu entwickelte und verbesserte Ressourcenallokation evidenzbasierter zu gestalten und somit qualitativ zu verbessern.…”