Integrated Care
Basic Principles and Evaluation of Care for People with Serious Mental Disorders
Within the scope of the Innovation Incubator, a major EU project, the competence tandem entitled “Integrated Care – Basic Principles and Evaluation of Care for People with Serious Mental Disorders” analyzes and evaluates an innovative approach to care for people with mental disorders. At first, the research team will focus on what measures are required to ensure optimal care of people with psychiatric diseases. As a second step, it is intended to implement and evaluate key elements of the care concept across the whole area jointly with the entrepreneur partner.
Brief Description
In Germany people with mental disorders are often cared for by different health care institutions acting independently from one another. Inpatient and outpatient healthcare centers are often not sufficiently interlinked. For example, a patient suffering from mental disorder may have been released from hospital after several months of treatment without notifying the patient’s treating psychiatrist accordingly. The lack of networking among the agents involved is not only cost-intensive, but also makes it more difficult to provide constant care customized to the individual patient’s needs. In Germany there is hardly any possibility to treat people with mental disorders at home. As a result, patients will be torn out of their familiar environment whenever they receive inpatient care, which, in turn, may strongly affect the course of their illness.
Particularly with chronic psychiatric disorders, effective treatment and care provided over a long period of time is of great importance. The decisive factor for success is providing long-term treatment of the patient rather than providing medical care in acute crises. To enable the patient to participate in life and find a stable position in different fields of life, efforts should be directed primarily to reducing the patient’s subjective and objective illness-related burden. The treatment provided by individual institutions is often insufficient, uncoordinated and not guided by the course of the illness and therefore has severe human, financial and social consequences.
If we succeed in optimizing care for people with mental disorders, there will be a huge human and economic potential. For example, schizophrenia and depression are among the most costly diseases to treat in Germany. In 2006, more than 700,000 patients received inpatient treatment, and more than 26 billion euros were spent on the treatment of mental diseases. Up to 50% of the population suffer, at least once in their lives, from mental disorders that require medical treatment. The most common disorders are fear-related disorders and depressions. According to current calculations (2001 World Health Report), the “people’s disease” of depression could become the disease involving the second largest burden in the world as early as in 2020. However, most of the people affected never receive adequate medical treatment.
The competence tandem aims at establishing an integrated system of care in and beyond the convergence region. The key idea of this innovative approach is to provide care for people with mental disorders within their familiar environment through outpatient therapists (case managers) in collaboration with psychiatrists as well as other service providers and agents (e.g. general practitioners, social psychiatric services). Patients will be offered the required medical services in their familiar environment, regardless of the respective institution’s location.
Internet-based models of care in the field of psychotherapy (“online therapy”) are considered another component in the treatment of mental disorders like depression. This type of care is centered on a new intervention that combines case management provided by general practitioners and online modules for patients.
Internet-based psychotherapeutic treatment has been developed for about 20 years and is increasingly gaining acceptance in countries like Great Britain, the Netherlands, U.S.A. or Australia. In particular, cognitive-behavioral approaches referring back to clinically-proven manual therapy (in the English-speaking world known also as CCBT) are used, in most cases to treat depression, burnout, fear-related disorders and post-traumatic stress disorders (PTBS).
Project Objectives
The problems related with sectoral care, i.e. a care system that is divided into single institutions acting independently from one another, are being openly discussed in both scientific literature and practice. The boundaries existing between the individual care sectors (e.g. outpatient or inpatient) can hardly be overcome with respect to permeability, continuous provision of care and transsectoral responsibilities for care. However, a great number of attempts at regional level attest to the success achieved in treating individual diseases due to the adoption of integrated care approaches. Up to now, no large-scale approaches applicable to all indications have been realized in Europe or particularly in the German healthcare system – therefore, these approaches are a true novelty.
In the field of healthcare research, top priority is given to the scholarly analysis of the feasibility and effectiveness of innovative approaches in caring for people with mental disorders. The following aspects are taken into account:
- Success of medical and psychiatric treatment
- Subjective evaluation of therapy by patients and quality of life
- Functioning and social stabilization of patients
In its publication on “Psychiatry in Germany – Structures, Services, Perspectives” (2007), the Psychiatry Working Group of the Supreme Health Authorities of the German federal states, acting on behalf of the German Conference of the Ministers of Health, criticizes explicitly that there are too few epidemiological data available regarding the extent of mental disorder and its treatment in the German population. Also, healthcare research in Germany is only just beginning to emerge, according to the Working Group. With regard to the scholarly potential, the competence tandem project therefore addresses a key research deficit in the field of health sciences.
The findings of the research project help the business partner select and use healthcare control instruments. At the same time, it is expected that new companies will be set up as a result of network effects at and above the regional level. Statutory health insurance companies and agents from the field of healthcare have already expressed great interest in the project findings during talks held in the preliminary stage of the project.
Project Realization
Chaired by Prof. Dr. med. Dipl.-Psych. Wulf Rössler and an international academic partner, the project runs for a period of 36 months with approximately 10 scientific staff members being employed in it.
Business partner of the project is IVPNetworks GmbH with registered office in Seevetal/Hittfeld. IVPNetworks GmbH, jointly with the service providers, develops and realizes outpatient healthcare networks for the treatment and care of patients with neurological and mental disorders within the scope of integrated programs. IVP, acting in its capacity as the management company, and the statutory health insurance companies will conclude agreements on integrated care.
In the initial project stage, the current state of medical and healthcare research will be analyzed, presented systematically, summarized and evaluated in accordance with the levels of scientific evidence indicated in the Cochrane Handbook for Systematic Reviews of Interventions.
The process of setting up a new healthcare system by the business partner is shaped by the interfaces between medicine, healthcare research and health economy. Up till now, there has been no interdisciplinary project of this kind. To establish an extensive healthcare chain that functions independently of and across any institutions, it is necessary to create a trans-disciplinary knowledge platform. The initial stage of the project aims at presenting an overall picture of the state of knowledge regarding key issues.
The objective of the second project stage is to provide a scholarly evaluation of the healthcare system as a whole and of the case management system as an important individual element. The focus lies on classical psychotic disorders. In the course of the project, the competence tandem will provide support in setting up mental health services in the rural districts of the project area. Toward the end of the project, it is planned to prepare publications and organize conferences to make the research findings available to both a wider academic public and experts in the field.
A second project under the same management will run for a period of 2.2 years with 5 additional academic staff members and another 3 research assistants being employed in it. This project is centered on online depression therapy provided by outpatient therapists (case managers). Business partner of this project is Novego AG with registered office in Seevetal. Novego AG develops web-based programs supporting the treatment of mild and moderate forms of depressions and other mental disorders; the programs are partially supported by a general practitioner or a psychotherapist. The contents of the programs are guided by the evidence-based cognitive-behavioral therapy.
The research project analyzes an innovative approach to improving treatment of people’s diseases in Germany. This allows to examine the Internet-based psychotherapy of depressions (“online therapy”) – a method of treatment which, in part, is well established abroad – in terms of effectiveness and efficiency in the German healthcare system by testing this method in practice rather than in a pilot program. In addition, online interventions within the scope of case management provided by a general practitioner may also result in reducing high dropout rates – one of the major weaknesses of previous intervention methods.