Christiane Roick

Health habits of patients with schizophrenia

BackgroundThe aim of the study was to analyze the physical activity, dietary, drinking, and smoking habits of schizophrenia patients (SP).MethodsData from 194 schizophrenia outpatients collected using sections of the German National Health Interview and Examination Survey were compared with data from the German general population (GP). In addition to univariate data analyses, a multivariate regression analysis was performed.ResultsSchizophrenia patients have a supper snack more frequently, consume instant meals and calorie-reduced food more frequently, and eat healthy groceries more rarely. Though they drink less alcohol, a greater proportion currently smokes, smoking on average 4 cigarettes more per day. On workdays they spend less time with strenuous activities, and in leisure time a greater proportion is involved in no sports. Regression analysis revealed that schizophrenia by itself or in interaction with demographic variables influences physical activity as well as alcohol, nicotine, and healthy grocery consumption. Health habits were particularly disadvantageously affected by schizophrenia in connection with unemployment.ConclusionsSchizophrenia patients are an appropriate target group for public health interventions. They need information about a healthy diet and motivation to prepare their own meals, to quit smoking, and to exercise.

The impact of caregivers’ characteristics, patients’ conditions and regional differences on family burden in schizophrenia: a longitudinal analysis

Objective:  Impact of caregiver characteristics, patient variables, and regional differences on family burden.

Factors contributing to frequent use of psychiatric inpatient services by schizophrenia patients.

Abstract.Background:Although present findings about frequent users of psychiatric inpatient services vary from study to study, some potentially important predictors of frequent use were extracted. The purpose of this study was to examine the potentially contributory factors of frequent use of psychiatric inpatient services by schizophrenia patients and to test the influence single factors have in an overall model.Methods:A total of 307 schizophrenia patients were interviewed five times with intervals of 6 months. Data were collected about service receipt and health care costs, strength of primary diagnosis and comorbidities, as well as about patients’ needs for care and satisfaction with care. Patients with three or more psychiatric admissions within a 30-month period were defined as frequent users.Results:According to this criterion, 12% of the study population were frequent users. Compared with ordinary users, these patients accounted for significantly higher costs in hospital- and community-based care. Important predictors for frequent use of psychiatric inpatient services were the number of previous hospitalizations and current scores of psychopathology. In addition, a longitudinal analysis showed the importance of social factors for the use of psychiatric inpatient care. Therefore, a number of the frequent users’ multiple admissions could also be caused by social problems.Conclusions:The mental health system should, thus, provide well-directed community-based resources, which give frequent users support to solve their social problems.

Cost-effectiveness of a primary care model for anxiety disorders

BACKGROUND Individuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care. AIMS To analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care. METHOD In a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation-liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up. RESULTS No significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ-5D during follow-up. Total costs were higher in the intervention group (euro4911 v. euro3453, P = 0.09). The probability of an incremental cost-effectiveness ratio <euro50 000 per quality-adjusted life year was below 10%. CONCLUSIONS The optimised care model did not prove to be cost-effective.

Utility assessment in patients with mental disorders: validity and discriminative ability of the time trade-off method.

AbstractBackground: Preference-based health-state values, also referred to as utility scores, are considered an important measure of outcome in the evaluation of healthcare. A common approach to elicit utility scores is the use of the time trade-off (TTO) method; however, the data on TTO utility scores in patients with mental disorders are scarce. Objective: To analyse the TTO method in patients with mental disorders in terms of discriminative ability, validity and the refusal to trade life time (zero trade). Methods: In patients with affective (n = 172), schizophrenia spectrum (n = 166) and alcohol-related (n = 160) mental disorders, TTO utilities were administered through a standardized interview. Measures of quality of life (QOL) [EQ-5D, WHOQOL-BREF], subjective (SCL-90R) and objective (CGI-S) psychopathology, and functioning (GAF, GARF, SOFAS, HoNOS) provided comparison. Discriminative ability was analysed by assessing frequency distributions of TTO utilities. Validity was analysed by assessing the correlation of TTO utilities with all other scores. The association of a patient’s QOL, sociodemographic and disease-related variables with zero trade was analysed by logistic regression. Results: Of patients with affective/schizophrenic/alcohol-related mental disorders, 153/143/145 (89/86/91%), respectively, completed the TTO elicitation; 29/43/28% of the respondents were zero traders. The mean TTO utility was 0.66/0.75/0.61 and the median was 0.85/0.95/0.75. TTO utility scores discriminated well among more impaired mental health states, but discrimination was limited among less impaired health states. In patients with affective and alcohol-related mental disorders, TTO utility scores were significantly correlated (mostly moderate: 0.3 < r < 0.5) with all other scores. However, in schizophrenic patients, TTO utility scores were only a little correlated with other subjective measures and not correlated with objective measures. QOL was significantly associated with zero trade; the influence of the other variables on zero trade was negligible. Conclusions: TTO utility scores in patients with affective or alcohol-related mental disorders were reasonably valid, but discriminative ability was compromised by a ceiling effect due to zero trade. In schizophrenic patients, validity of TTO utility scores was not demonstrated.

Accuracy of self-reports of mental health care utilization and calculated costs compared to hospital records.

Assessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.

Das Regionale Psychiatriebudget (RPB): Ein Modell für das neue pauschalierende Entgeltsystem psychiatrischer Krankenhausleistungen?

OBJECTIVE To analyze the impact of a capitated multi-sector-financing model for psychiatric care (RPB) on costs and effectiveness of care. METHODS Patients with a diagnosis according to ICD-10 F10, F2 or F3 were interviewed in the model region (MR, n = 258) and a control region (CR, n = 244) financed according to the fee-for-service principle. At baseline, 1.5 years and 3.5 years follow-up patients were interviewed using measures of psychopathology (CGI-S, HoNOS, SCL-90R, PANSS, BRMAS / BRMES), functioning (GAF, SOFAS) and quality of life (WHOQOL-BREF, EQ-5D). Use of care was determined semi-annually. RESULTS There were no significant differences in the development of psychopathology and quality of life between MR and CR. In the MR, functioning of patients with schizophrenia and affective disorders improved significantly more strongly. The development of total mental health care costs was not different between MR and CR. However, the costs of office based mental health care increased slightly more strongly in the MR, indicating a small cost-shift from the RPB to extrabudgetary financed services. CONCLUSIONS The RPB showed slight advantages regarding the effectiveness of care and did not significantly change the total mental health care costs.

[The regional psychiatry budget: costs and effects of a new multisector financing model for psychiatric care].

OBJECTIVE To evaluate a new multi-sector financing model for psychiatric care based on the capitation principle (Regional Psychiatry Budget, RPB). METHODS Patients with a diagnosis according to ICD-10 F10, F2, and F3 were interviewed in the model region (MR, N=258) and a control region (CR, N=244) financed according to the fee-for-service principle. Effectiveness of care was assessed before RPB-introduction and after 1.5 years. Use of care was determined semi-annually. RESULTS Costs of inpatient psychiatric treatment decreased more strongly in the MR, while hospital based outpatient care and day clinic treatment were intensified in comparison to the CR. Quality of life, severity of illness and illness-specific symptoms in patients improved similarly in MR and CR. The functional level improved more in the MR than in the CR, which was especially evident in schizophrenia patients. CONCLUSIONS Inpatient psychiatric care costs can be reduced with the RPB without compromising the quality of care.

Heavy Use of Psychiatric Inpatient Care from the Perspective of the Patients Affected

Background: Patients who spend an above-average amount of time in inpatient care are termed heavy users. Up to this point, very little has been known about what drives these patients to their heavy use of inpatient treatment. Aim: For this reason, the present study investigates the causes for frequent inpatient admissions of heavy users from the perspective of the patients affected. Methods: Twenty heavy users who were identified in a quantitative preliminary study were interviewed using a qualitative analysis of the contents. Results: Heavy users housed in sheltered accommodation either experienced frequent inpatient stays because of their symptomatic burden, or because of poor integration in their residences. Among the heavy users living in private residences was a subgroup that compensated for the lack of support from the private sphere with frequent hospital visits. A second subgroup turned to hospital care only during acute relapse episodes. In a third subgroup, secondary substance abuse accounted for the high demand for inpatient treatment. Conclusion: Findings suggest that, using community-based psychiatric support offers tailored to the needs of the heavy user subgroups, inpatient treatment could be avoided.

Cost-effectiveness of mental health service systems in the European comparison

As other sectors of medical care, mental health care has to struggle with the problems of raising health care costs and the limitations of financial resources (Hafner et al. 1991; Knapp et al. 1990; Salize et al. 1996). And as in somatic medicine, most mental health experts agree that the current financial problems should not be solved by reducing the standard of care but by improving the efficiency of existing and by developing more efficient treatment methods (John et al. 2001; Wasem et al. 2001). Most experts further agree that health economic methods such as cost-outcome analysis are important tools for the assessment of treatment efficiency and for the forecasting of the possible economic consequences of innovative treatment strategies (Knapp 2000).