Innovative Versorgungsstrategien in der Gerontopsychiatrie und -psychotherapie

Holthoff-Detto, Vjera

doi:10.1007/s00115-014-4179-3

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…25,26 However, the evidence for innovative mental health care strategies for elderly people is scarce. 27 Most studies using ACT, [28][29][30] HT, [31][32][33][34][35] or CRT [36][37][38] did not specifically report whether the innovative care models reduced AHLS in geriatric populations with mental health care needs. A British study showed that CRT and HT significantly reduced admissions of elderly mentally ill patients, but there was no significant difference in AHLS as compared before and after the introduction of these services.…”

Section: Procedures In Medicine Of the World Health Organization Calledmentioning

confidence: 99%

“…Studies of home treatment for older people with physical illness showed that these services help to reduce the number of acute admissions and AHLS . However, the evidence for innovative mental health care strategies for elderly people is scarce . Most studies using ACT, HT, or CRT did not specifically report whether the innovative care models reduced AHLS in geriatric populations with mental health care needs.…”

Section: Introductionmentioning

confidence: 99%

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Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany

Ignatyev

Mundt

Peter

et al. 2019

Int J Geriat Psychiatry

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Objective Since 2012, a new law (§64b, Book V of the Social Security Code [SGB V]) regulates the implementation of flexible and integrative psychiatric treatment projects (FIT64b) in Germany. FIT64b allows rapid discharge of patients from inpatient to outpatient settings and cost reductions of hospital stays. Several psychiatric centres exclusively provide FIT64b; others provide FIT64b alongside with standard health care. The aim of the study was to assess the average hospital length of stay (AHLS) of older patients with mental illness included in FIT64b projects. Methods A secondary data analysis was conducted using administrative data from eight German mental health centres providing FIT64b. The effects of gender, age, type of centre, and main diagnosis on AHLS were calculated for all older patients with age 65 years or older (n = 3495) treated in FIT64b in the year 2016. Data were analysed with descriptive statistics and robust multiway procedures. Results The AHLS of older people with mental illness was 4.8 (SD = 11.5) days. The AHLS was shorter in centres exclusively providing FIT64b than in centres providing FIT64b alongside with standard health care: 3.2 (SD = 6.4) vs 8.4 (SD = 17.8) days, P = .001. This difference was particularly marked among patients with schizophrenia spectrum disorders, mood disorders, and neurotic, stress‐related, and somatoform disorders. Conclusions FIT64b relates to very short AHLS even among older people. Centres using FIT64b alongside with standard health care usually provide standard care to most patients, which could lead to lower fidelity in the implementation of FIT64b.

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Section: Procedures In Medicine Of the World Health Organization Calledmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany

Ignatyev

Mundt

Peter

et al. 2019

Int J Geriat Psychiatry

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“…B. beim physischen Zugang zur psychotherapeutischen Praxis oder der Fähigkeit, regelmäßige Termine einzuhalten. Komorbidität und Psychotherapie ist ein Thema, das in jüngerer Zeit in der Fachliteratur zunehmend thematisiert wird [7]. Unterstützungsangebote wie z.…”

Section: Besondere Herausforderung: Komorbidität Und Funktionale Einsunclassified

“…Depressive Erkrankungen bei älteren Menschen und ihre Behandlung finden in der Fachliteratur zunehmend Beachtung. Diskutiert werden u. a. eine Unterversorgung und Zugangsbarrieren [1][2][3] sowie die Notwendigkeit spezialisierter Versorgungsformen [4][5][6][7].…”

Section: Introductionunclassified

Hindernisse und Voraussetzungen für die Vermittlung älterer, depressiv erkrankter Menschen in Psychotherapie aus Sicht von HausärztInnen

et al. 2016

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Older people with depressive disorders access psychotherapy less frequently than younger ones. GPs play an important role in referring patients, particularly the elderly, to psychotherapeutic treatment. This paper presents the obstacles to and preconditions for referring older, depressed sick people to psychotherapy from the point of view of GPs. Doctors who are training GPs were given a questionnaire on the care of the elderly (60+) with depressive disorders. In 2 open questions, they were requested to state their views on obstacles to and preconditions for referring older, depressed diseased people to psychotherapeutic treatment. Most statements related to obstacles perceived by patients followed by barriers on the part of the supply system. Especially obstructive attitudes and emotions, but also functional limitations on the part of patients were referred to as barriers. With regard to the supply system, structural aspects, such as lack of psychotherapy places, but also the actions of care providers and insufficient cooperation were listed. As preconditions, specific therapy for the elderly were mentioned Dealing with reservations about psychotherapy on the part of older people takes time, which usually is not reimbursed in general practice. Collaborations with psychotherapists are seen as an important precondition for referral. Especially for people with multiple illnesses, access is considered difficult.

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“…Its patient population has higher prevalence of dementia (Weyerer, 2005; Zank et al , 2009) and higher subdiagnostic criteria for depression (Linden et al , 1998; Wolff and Tesch-Römer, 2017) (Busch et al , 2013). They also have limited access to outpatient services (Holthoff, 2015), which leads to an increase of severely and chronically ill patients in GerP (Hirsch, 2016). Those circumstances indicate that GerP has a higher structural complexity than general psychiatry (GenP), which is traditionally expected to correspond with more difficulties in implementing innovations (Duncan, 1976).…”

Section: Introductionmentioning

confidence: 99%

Considering the role of context when implementing government policies in hospitals: introduction of a prospective payment system for psychiatry

Schippel

Hower

Zank

et al. 2021

JHOM

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PurposeThe context in which an innovation is implemented is an important and often neglected mediator of change. A prospective payment system (PPS) for psychiatric and psychosomatic facilities with major implications for inpatient psychiatric care in Germany was implemented from 2013 to 2017. This study aims to examine the determinants of implementation of this government policy using the Diffusion of Innovations theory and consider the role of context.Design/methodology/approachAn exploratory case study was conducted in two wards of a psychiatric hospital in Germany: geriatric psychiatry (GerP) and general psychiatry (GenP). Fifteen interviews were conducted with different occupational groups and analyzed in-depths. Routine hospital data were analyzed for delimiting the two contexts.FindingsRoutine hospital data show a higher day-mix index (1.08 vs. 0.94) in the GerP context and a very different structure regarding PPS groups, indicating a higher patient complexity. Two types of factors influencing implementation were identified: Context-independent factors included social separation between nurses and doctors, poor communication behavior between the groups and a lack of conveying information about the underlying principles of the PPS. Context-dependent factors included compatibility of the new requirements with existing routines and the relative advantage of the PPS, which were both perceived to be lower in the GerP context.Practical implicationsDepending on the patient characteristics in the specific context, compatibility with existing routines should be ensured when implementing. Clear communication of the underlying principles and reduction of organizational and communicative barriers between professional groups are crucial success factors for implementing such innovations.Originality/valueThis study shows how a diffusion process takes place in an organization even after the organization adopts an innovation. The authors could show how contextual differences in terms of patient characteristics result in different determinants of implementation from the views of the employees affected by the innovation.

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Innovative Versorgungsstrategien in der Gerontopsychiatrie und -psychotherapie

Cited by 8 publications

References 27 publications

Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany

Hospital length of stay among older people treated with flexible and integrative psychiatric service models in Germany

Hindernisse und Voraussetzungen für die Vermittlung älterer, depressiv erkrankter Menschen in Psychotherapie aus Sicht von HausärztInnen

Considering the role of context when implementing government policies in hospitals: introduction of a prospective payment system for psychiatry

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