How does the integration of collaborative care elements in a gatekeeping system affect the costs for mental health care in Germany?

Engels, Alexander; Reber, K.; Magaard, Julia Luise; Härter, Martin; Hawighorst-Knapstein, S; Chaudhuri, Ariane; Brettschneider, Christian; König, Hans‐Helmut

doi:10.1007/s10198-020-01170-3

Cited by 3 publications

(10 citation statements)

References 40 publications

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“…Hence, the relative benefit of PNP in terms of waiting times for psychotherapy should be higherespecially considering that patients with more sick leave days are common and benefit even more (see supplemental figure 4) and treatment rates have an upper constraint due to patients actively deciding against treatment. Reducing waiting times for patients who are contributing the most to high productivity losses could explain the reduction of sick leave days and sick pay observed in our recent analysis [36]. Moreover, this result is plausible considering that the specialist program changed access guidelines with regard to psychotherapy and implemented a stepped payment scheme that incentivizes timely treatment for acute and severe cases [37] Moreover, in a recent provider survey enrolled psychotherapists reported that the PNP contract facilitates timely and needoriented access [35].…”

Section: Interpretation Of the Resultsmentioning

confidence: 76%

“…In this analysis, we aimed to find mediators that could explain the reduction of sick pay and sick leave days due to common mental disorders in the specialist program, which we found when we compared the costs for the treatment of common mental disorders between the specialist program, the GP program and UC [36]. We examined whether the specialists' program increased the rate of patients that received guideline adherent depression treatment or if the regulations in the specialists' program Fig.…”

Section: Interpretation Of the Resultsmentioning

confidence: 99%

“…We conducted a retrospective observational cohort study based on SHI claims data from 2014 to 2016 of the AOK BW to identify, balance and compare three cohorts of either UC, GP or specialists' program patients with depression. In view of our aim to identify mediators that explain our previous findings, we wanted to maintain comparability to our previous analysis by using similar inclusion criteria [36]. Consistently, we only included patients that received a sick leave diagnosis in 2015 due to one of the mental disorders listed in Table 1.…”

Section: Study Design and Samplementioning

confidence: 99%

“…So far, a provider survey [35] and a cost comparison [36] were published from the multiperspective evaluation of the PNP contract [37], but both studies have not obtained reliable evidence for potential mediators of the contract. In the survey, providers reported general satisfaction with the contract and the vast majority stated that the treatment of patients with chronic conditions or an acute crisis had improved e.g.…”

Section: Introductionmentioning

confidence: 99%

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Depression treatment in Germany – using claims data to compare a collaborative mental health care program to the general practitioner program and usual care in terms of guideline adherence and need-oriented access to psychotherapy

et al. 2020

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Background Societies strive for fast-delivered, evidence-based and need-oriented depression treatment within budget constraints. To explore potential improvements, selective contracts can be implemented. Here, we evaluate if the German collaborative psychiatry-neurology-psychotherapy contract (PNP), which extends the gatekeeping-based general practitioner (GP) program, improved guideline adherence or need-oriented and timely access to psychotherapy compared to usual care (UC). Methods We conducted a retrospective observational cohort study based on health insurance claims data. After we identified patients with depression who were on sick leave due to a mental disorder in 2015, we applied entropy balancing to adjust for selection effects and employed chi-squared tests to compare guideline adherence of the received treatment between PNP, the GP program and UC. Subsequently, we applied an extended cox regression to assess need-orientation by comparing the relationship between accumulated sick leave days and waiting times for psychotherapy across health plans. Results N = 23,245 patients were included. Regarding guideline adherence, we found no significant differences for most severity subgroups; except that patients with a first moderate depressive episode received antidepressants or psychotherapy more often in UC. Regarding need-orientation, we observed that the effect of each additional month of sick leave on the likelihood of starting psychotherapy was increased by 6% in PNP compared to UC. Irrespective of the health plan, we found that within the first 12 months only between 24.3 and 39.7% (depending on depression severity) received at least 10 psychotherapy sessions or adequate pharmacotherapy. Conclusions The PNP contract strengthens the relationship between sick leave days and the delay until the beginning of psychotherapy, which suggests improvements in terms of need-oriented access to care. However, we found no indication for increased guideline adherence and – independent of the health plan – a gap in sufficient utilization of adequate treatment options.

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Section: Interpretation Of the Resultsmentioning

confidence: 76%

Section: Interpretation Of the Resultsmentioning

confidence: 99%

Section: Study Design and Samplementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Depression treatment in Germany – using claims data to compare a collaborative mental health care program to the general practitioner program and usual care in terms of guideline adherence and need-oriented access to psychotherapy

et al. 2020

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“…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.…”

Section: Diskussionunclassified

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

et al. 2020

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Zusammenfassung Ziel Evaluation der Akzeptanz sowie der Struktur- und Prozessqualität des PNP-Vertrags aus Sicht der teilnehmenden Behandelnden. Methodik Auf Basis qualitativer Interviews (n = 9) wurde ein Fragebogen entwickelt. Alle teilnehmenden Behandelnden (n = 720) wurden zur Befragung eingeladen. Ergebnisse N = 430 Behandelnde (81 % Psychotherapeuten, 2 % Psychiater, 2 % Neurologen, 15 % mit mehreren Fachgebieten) nahmen an der Befragung teil (60 %). Mit dem PNP-Vertrag waren 94 % zufrieden. Schlussfolgerung Die überwiegende Akzeptanz stellt eine gute Basis dar, um die Umsetzung der vereinbarten Versorgungsinhalte nachhaltig zu fördern. Die Ergebnisse können der Weiterentwicklung der Prozess- und Strukturqualität dienen (z. B. zur Einschreibung und Abrechnung).

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Effectiveness of a coordinated ambulatory care program for patients with mental disorders or multiple sclerosis: results of a prospective non-randomized controlled trial in South Germany

Seeralan,

Magaard,

Engels

et al. 2023

Front. Psychiatry

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BackgroundThe Psychiatry, Neurology, Psychosomatics and Psychotherapy (PNP) program of the German statutory health insurance AOK BW promotes coordinated and evidence-based specialist care with the aim of providing individualized, guideline-based outpatient care, strengthening the collaboration between health care providers, as well as reducing care costs. The purpose of this study was to evaluate its effectiveness regarding patient-reported outcomes compared to the less specialized general practitioner program (GP) and usual care (UC).Materials and methodsAOK insured patients, who were on sick leave due to a mental disorder (affective disorder, anxiety disorder, adjustment disorder, somatoform disorder, alcohol abuse disorder, schizophrenia) or multiple sclerosis were included in the prospective non-randomized controlled study. All patients either participated in the PNP program (intervention group, IG-PNP), the general practitioner program (control group, CG-GP) or usual care (control group, CG-UC). Entropy balancing was used to adjust for baseline imbalance between groups. Primary outcome was health-related quality of life, assessed by the Short-form health survey (SF-36) 12 months after diagnosis. Secondary outcomes included symptom severity, functional health, and treatment satisfaction.ResultsOf the 14,483 insured patients who were contacted, 1,104 patients participated at baseline and 725 at follow-up. The adjusted mean differences of SF-36 sum score did not significantly differ between groups: −1.89 (95%-CI = −4.60; 0.81, p = 0.170) between IG-PNP and CG-GP, and −1.42 (95%-CI = −4.05; 1.22, p = 0.293) between PNP and CG-UC. The adjusted mean differences of secondary outcomes did not differ between groups, except for a slightly higher increase of functional health in CG-UC.ConclusionWe found no evidence that the PNP program is superior to the GP program or to usual care in terms of patient-reported outcomes or treatment satisfaction. The results are limited by the low response rate. Accordingly, future studies should strive for more representative samples. To improve the program, an integration of further collaborative care elements and guideline recommendations might be useful.Clinical trial registrationDRKS (German Clinical Trials Register https://drks.de/search/en); identifier (DRKS00013114).

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How does the integration of collaborative care elements in a gatekeeping system affect the costs for mental health care in Germany?

Cited by 3 publications

References 40 publications

Depression treatment in Germany – using claims data to compare a collaborative mental health care program to the general practitioner program and usual care in terms of guideline adherence and need-oriented access to psychotherapy

Depression treatment in Germany – using claims data to compare a collaborative mental health care program to the general practitioner program and usual care in terms of guideline adherence and need-oriented access to psychotherapy

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

Effectiveness of a coordinated ambulatory care program for patients with mental disorders or multiple sclerosis: results of a prospective non-randomized controlled trial in South Germany

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