Wer erhält wie viel Versorgung in der Institutsambulanz und warum?

 

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Zusammenfassung

Anliegen/Methode In einer psychiatrischen Institutsambulanz sollten die Zusammenhänge zwischen individuellen Fallaspekten und Behandlungsaufwand mittels multipler linearer Regression dargestellt werden. Ergebnisse Niedrigerer Behandlungsaufwand war assoziiert mit Wohnen im Heim (β = − 0,319; p < 0,001), höherem Alter (β = − 0,238; p < 0,001), einer bestehenden BGB-Betreuung (β = − 0,165; p = 0,006) und eigenem Erwerbseinkommen (β = − 0,100; p = 0,044). Ein Mehraufwand war mit vorheriger stationärer psychiatrischer Behandlung verbunden (β = 0,181, p = 0,001 resp. β = 0,193; p < 0,001). Schlussfolgerungen Die Ergebnisse eröffnen Fortentwicklungsmöglichkeiten für die Fallvergütung.

Abstract

Aims To elucidate the connections between individual aspects and patients' concerns and the care effort provided in a clinic for the sickest among outpatients. Methods Clients of one health insurer were followed for six months (n = 339) in a „Institutsambulanz” or „PIA”. All treatment activities, which involved roughly 100 000 working minutes, were recorded. Sociodemographic data, the diagnoses, the individual needs and idiosyncracies, symptoms and case history were noted for multivariate analysis. Results The linear regression model with the best fit (n = 251, r² = 0.512, p < 0.001) included six variables. Lower efforts: living in nursing home (β = − 0.319; p < 0.001), higher age (β = − 0.238; p < 0.001), legal incapacity (β = − 0.165, p = 0.006), own work income (β = − 0.100; p = 0.044); higher efforts: inpatient stays prior to study treatment (lifetime: β = 0.181; p = 0.001; number of days in last two years: β = 0.193; p < 0.001). Treatment aims, functional deficits, and diagnoses did not have a significant influence. Conclusions Younger patients who wish for an independent life despite of a grave psychiatric disorder may effectuate higher treatment efforts. Treatments administered to nursing-home inhabitants are far less complex, although these patients are even sicker. The current reimbursement mechanism may serve as a disincentive towards care administration according to individual need.

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Dr. med. Felix Wedegärtner, MPH

Medizinische Hochschule Hannover, Zentrum für seelische Gesundheit, Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie

Carl-Neuberg-Straße 1

30625 Hannover

Email: wedegaertner.felix@mh-hannover.de