Michael Löhr

Berechnung der Personalbemessung bei einer Umsetzung von 100 % Psych-PV: Kann diese auf der Grundlage vorliegender Routinedaten erfolgen?

ZusammenfassungNach Abschluss der Konvergenzphase wird am 01.01.2019 die Psychiatriepersonalverordnung (Psych-PV) nicht mehr Grundlage der Verhandlungen der psychiatrischen Fachkliniken und Abteilungen mit den Krankenkassen sein. Stattdessen wird das pauschalierende Entgeltsystem für psychiatrische und psychosomatische Einrichtungen den neuen Rahmen darstellen. Der Gemeinsame Bundesausschuss (G-BA) hat die Aufgabe erhalten, auf der Grundlage der Psych-PV eine Richtlinie zu erstellen, um die notwendige Personalbemessung zu definieren. Dies setzt voraus, dass belastbare Daten zur Einstufung von Patienten nach Psych-PV in den psychiatrischen Kliniken und Abteilungen vorhanden sind und darauf basierend eine exakte Berechnung des den Kliniken zustehenden Personals möglich sein wird.Dieser Artikel zeigt, dass dies mit Daten des sog. §-21-Datensatzes aus der Datenbank des Projektes „Versorgungsrelevante Indikatoren in der Psychiatrie und Psychosomatik“ (VIPP) möglich ist. Diese VIPP-Daten wurden als Ausgangspunkt der Berechnung des Personalbedarfs genutzt. In den exemplarischen Auswertungen wird deutlich, dass die vorliegenden Informationen zur Psych-PV sich annäherungsweise in Minuten/Tag, Minuten/Monat und Vollkraftstellen umrechnen lassen. Damit stünden diese Informationen grundsätzlich auch dem Institut für das Entgeltsystem im Krankenhaus (InEK) zur Verfügung.SummaryFrom 1 January 2019, after completion of the convergence phase, the Psychiatry Personnel Act (Psych-PV) will no longer be the basis of budget negotiations of psychiatric hospitals and departments with the health insurance funds in Germany. Instead, the new compounding remuneration system for psychiatric and psychosomatic inpatient institutions (PEPP) will provide a new framework. The Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) has been given the task of elaborating a directive on the basis of the expiring Psych-PV in order to redefine standards for personnel allocation within this new framework. This task presupposes the existence of reliable data in the psychiatric hospitals and departments for categorizing patients following the Psych-PV. It presupposes further that these data allow an exact calculation of the personnel to which the clinics are entitled. This article shows that the so-called §-21 dataset from the database of the VIPP project (indicators of patient care in psychiatric and psychosomatic facilities) allows this calculation. The VIPP dataset was used as a basis to calculate the personnel requirements. Exemplary analyses illustrate that the information available regarding the Psych-PV can be transformed in minutes per day, minutes per month and full time positions. Therefore, this information would also be available to the Institute for the Hospital Remuneration System (InEK).From 1 January 2019, after completion of the convergence phase, the Psychiatry Personnel Act (Psych-PV) will no longer be the basis of budget negotiations of psychiatric hospitals and departments with the health insurance funds in Germany. Instead, the new compounding remuneration system for psychiatric and psychosomatic inpatient institutions (PEPP) will provide a new framework. The Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) has been given the task of elaborating a directive on the basis of the expiring Psych-PV in order to redefine standards for personnel allocation within this new framework. This task presupposes the existence of reliable data in the psychiatric hospitals and departments for categorizing patients following the Psych-PV. It presupposes further that these data allow an exact calculation of the personnel to which the clinics are entitled. This article shows that the so-called §-21 dataset from the database of the VIPP project (indicators of patient care in psychiatric and psychosomatic facilities) allows this calculation. The VIPP dataset was used as a basis to calculate the personnel requirements. Exemplary analyses illustrate that the information available regarding the Psych-PV can be transformed in minutes per day, minutes per month and full time positions. Therefore, this information would also be available to the Institute for the Hospital Remuneration System (InEK).

Low-Intensity Cognitive Behavioral Therapy (LI-CBT) – Eine Einführung in Konzepte und Rahmenbedingungen

Low-intensity cognitive behavioural therapy (LI-CBT) depicts interventions that aim at increasing access to evidence-based psychological therapies. This is achieved by (1) reducing the amount of time in which the practitioner is in contact with individual patients, (2) using practitioners that have been specifically trained to deliver low intensity interventions and without any prior formal health professional qualifications and (3) use of interventions with varying intensity. Stepped care and collaborative care constitute the organizational frame to deliver low-intensity interventions. Whereas large-scale research and health service projects abroad are focussing on LI-CBT, research in German is lagging far behind. Particularly in the light of the growing demands and utilization of mental health care as well as governmental claims to develop and evaluate new forms of providing mental health services, LI-CBT represents a promising approach.

Die Pflege-Patienten-Relationen in Psychiatrie und Psychosomatik (PPR-PP) – die pflegerische Basisbesetzung in der Behandlung Erwachsener

Zusammenfassung Fragestellung: Ziel dieser Arbeit ist es, auf der Grundlage interner und externer Evidenz die Basisbesetzung einer verantwortbaren Pflege-Patienten-Relation in der teilstationaren und stationaren Behandlung Erwachsener sowohl in der Psychiatrie als auch der Psychosomatik (PPR-PP) in Deutschland zu definieren. Hierdurch soll auch zukunftig die Patientensicherheit, weitgehend unabhangig vom aktuellen Finanzierungssystem, gewahrleistet werden. Methoden:Nach Identifikation und Berechnung der Basispflegeleistungen (1.) nach Psych-PV sowie (2.) unter Berucksichtigung von personellemMehraufwand durch normative Vorgaben werden (3.) die Zeitwerte, erganzt um Ergebnisse interner und externer Evidenz, in die PPRPP- Level-Struktur uberfuhrt. Ergebnisse: Es lassen sich sieben Level-Definitionen der PPR-PP definieren. Der Unterschied zur Basisbesetzung der Psych-PV liegt je nach Level zwischen +0.5 und +3.81 Stellen im Tagdienst. Fur den Nachtdienst werden ebenfalls Pflege-Patienten-Relationen fur die s...

Leitlinienkonforme psychiatrisch-psychotherapeutische Behandlung für Patienten mit Schizophrenie

BACKGROUND Although national treatment guidelines and current publications of the German Federal Joint Committee (Gemeinsamer Bundesausschuss) recommend cognitive behavior therapy for all patients with schizophrenia, the implementation of these recommendations in current inpatient and outpatient treatment is only rudimentary. OBJECTIVES The aim of this study was to systematically search randomized controlled studies (RCTs), meta-analyses and the guidelines of the German Association for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) and the British National Institute for Health and Clinical Excellence (NICE) in order to assess the number of personnel necessary for psychiatric and therapeutic inpatient treatment in line with present guidelines. Moreover, the number of staff required was compared with the personnel resources designated by the German psychiatry personnel regulations (Psych-PV). METHODS The German and NICE guidelines, RCTs and meta-analyses were analyzed and an adequate weekly treatment plan for an inpatient unit was developed. Moreover, the number of personnel necessary to realize the treatment plan was calculated. RESULTS In order to realize adequate inpatient treatment approximately 107 min extra for medical psychotherapeutic personnel per patient and week (of which 72 min for psychotherapy) and another 60 min for nursing staff per patient and week are required in addition to the current Psych-PV regulations. Thus, implementation in an open ward with 20 inpatients would require 3.62 positions for physicians, 0.7 positions in psychology and 12.85 positions for nursing staff (including management positions and night shifts). DISCUSSION These evidence-based recommendations for precise specifications of inpatient treatment should lead to improved inpatient treatment in line with present guidelines. Moreover, outpatients and day patients could be included in this treatment model. The results should be considered in the construction of the future prospective payment system for inpatient psychiatric healthcare in Germany.

Berechnung der Personalbemessung bei einer Umsetzung von 100 % Psych-PV

ZusammenfassungNach Abschluss der Konvergenzphase wird am 01.01.2019 die Psychiatriepersonalverordnung (Psych-PV) nicht mehr Grundlage der Verhandlungen der psychiatrischen Fachkliniken und Abteilungen mit den Krankenkassen sein. Stattdessen wird das pauschalierende Entgeltsystem für psychiatrische und psychosomatische Einrichtungen den neuen Rahmen darstellen. Der Gemeinsame Bundesausschuss (G-BA) hat die Aufgabe erhalten, auf der Grundlage der Psych-PV eine Richtlinie zu erstellen, um die notwendige Personalbemessung zu definieren. Dies setzt voraus, dass belastbare Daten zur Einstufung von Patienten nach Psych-PV in den psychiatrischen Kliniken und Abteilungen vorhanden sind und darauf basierend eine exakte Berechnung des den Kliniken zustehenden Personals möglich sein wird.Dieser Artikel zeigt, dass dies mit Daten des sog. §-21-Datensatzes aus der Datenbank des Projektes „Versorgungsrelevante Indikatoren in der Psychiatrie und Psychosomatik“ (VIPP) möglich ist. Diese VIPP-Daten wurden als Ausgangspunkt der Berechnung des Personalbedarfs genutzt. In den exemplarischen Auswertungen wird deutlich, dass die vorliegenden Informationen zur Psych-PV sich annäherungsweise in Minuten/Tag, Minuten/Monat und Vollkraftstellen umrechnen lassen. Damit stünden diese Informationen grundsätzlich auch dem Institut für das Entgeltsystem im Krankenhaus (InEK) zur Verfügung.SummaryFrom 1 January 2019, after completion of the convergence phase, the Psychiatry Personnel Act (Psych-PV) will no longer be the basis of budget negotiations of psychiatric hospitals and departments with the health insurance funds in Germany. Instead, the new compounding remuneration system for psychiatric and psychosomatic inpatient institutions (PEPP) will provide a new framework. The Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) has been given the task of elaborating a directive on the basis of the expiring Psych-PV in order to redefine standards for personnel allocation within this new framework. This task presupposes the existence of reliable data in the psychiatric hospitals and departments for categorizing patients following the Psych-PV. It presupposes further that these data allow an exact calculation of the personnel to which the clinics are entitled. This article shows that the so-called §-21 dataset from the database of the VIPP project (indicators of patient care in psychiatric and psychosomatic facilities) allows this calculation. The VIPP dataset was used as a basis to calculate the personnel requirements. Exemplary analyses illustrate that the information available regarding the Psych-PV can be transformed in minutes per day, minutes per month and full time positions. Therefore, this information would also be available to the Institute for the Hospital Remuneration System (InEK).From 1 January 2019, after completion of the convergence phase, the Psychiatry Personnel Act (Psych-PV) will no longer be the basis of budget negotiations of psychiatric hospitals and departments with the health insurance funds in Germany. Instead, the new compounding remuneration system for psychiatric and psychosomatic inpatient institutions (PEPP) will provide a new framework. The Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) has been given the task of elaborating a directive on the basis of the expiring Psych-PV in order to redefine standards for personnel allocation within this new framework. This task presupposes the existence of reliable data in the psychiatric hospitals and departments for categorizing patients following the Psych-PV. It presupposes further that these data allow an exact calculation of the personnel to which the clinics are entitled. This article shows that the so-called §-21 dataset from the database of the VIPP project (indicators of patient care in psychiatric and psychosomatic facilities) allows this calculation. The VIPP dataset was used as a basis to calculate the personnel requirements. Exemplary analyses illustrate that the information available regarding the Psych-PV can be transformed in minutes per day, minutes per month and full time positions. Therefore, this information would also be available to the Institute for the Hospital Remuneration System (InEK).

Aufnahme- und Entlassentscheidungen in der Psychiatrie

BACKGROUND The legislation requires all scientific societies in the field of inpatient psychiatric and psychosomatic healthcare to survey and assess the effects and financial incentives of the new flat rate day-based remuneration system in psychiatric and psychosomatic facilities (PEPP system). As day-based remuneration systems may be an incentive to extend treatment, it is necessary to measure and analyze the future development of the number of cases and the duration of treatment. OBJECTIVES This article surveys admission and discharge decisions of psychiatric and psychosomatic facilities. The distribution of admissions and discharges throughout the days of the week were analyzed to search for evidence of a systematic extension of treatment over the weekend. MATERIAL AND METHODS The analysis is based on data from the Versorgungsrelevante Indikatoren in der Psychiatrie und Psychosomatik (VIPP, treatment-relevant indicators in psychiatry and psychosomatics) project database, which contains routine data from psychiatric and psychosomatic facilities. On this basis the distributions of admissions and discharges throughout the days of the week were analyzed on aggregate and diagnosis-specific levels. RESULTS Patients were mostly admitted to hospitals within the first 3 weekdays. The discharge mostly took place on Fridays and not as a financial incentive on Mondays. Regarding the patient length of stay a 7-day cycle can be observed, which may indicate the importance of medical and organizational factors in discharge decisions. CONCLUSION The results do not show evidence for a systematic extension of treatment over the weekend. Over the next years it will be important to observe the development of the duration of treatment and the number of cases to assess the influence of the economic incentives of the PEPP system on the utilization of psychiatric and psychosomatic healthcare.

Veränderungen von Aufgaben und Tätigkeitsprofilen in der vollstationären psychiatrisch-psychotherapeutischen Intensivbehandlung in Deutschland

In Germany, mandatory standards in staff job characteristics concerning inpatient (clinic and day clinic) treatment in psychiatry and psychotherapy were established for the very first time in the year 1990. Those job characteristics, concerning the several groups of professionals in German psychiatric-psychotherapeutic hospitals and departments underwent significant changes causing issues of law, professional and socio-cultural development since then. Besides general structurally changes, the present article focuses more particularly on the field of inpatient psychiatric intensive care therapy.

Das neue Entgeltsystem in der Psychiatrie – gehören ältere Patienten zu den Verlierern? Eine Analyse auf der Grundlage der VIPP-Datenbank

The development of the lump-sum reimbursement System in psychiatry and psychosomatics (PEPP) (Klimke et al., 2014) is being negatively considered - also in gerontopsychiatry.Thus it is reasonable to make a timely analysis of the effects of PEPP on health-care structures. For this two analyses have been carried out. On the one hand the day mix index of elderly patients (> 64 years) was compared with that of younger ones (> 17 years, < 65 years). On the other hand younger and older were included in the analysis with regard to the available treatment minutes in exact daily classifications according to the PsychPV. It is seen that evaluation of the individual day was markedly higher for gerontopsychiatric patients not only in inpatient (difference > 0.1) but also in outpatient (difference > 0.07) setting. The exact daily classifications according to PsychPV, however, were markedly poorer for the elderly patients. Thus, on the basis of routine data of VIPP projects, a clear change can be seen in favour of the elderly patient under PEPP conditions as compared to financing according to PsychPV. However, concern remains that the ageing population and modernisation of therapy are not being sufficiently taken into account. The new reimbursement system merely regulates the distribution of available resources; if these resources are too low nothing will change by the PEPP-System.

Schutzkonzepte in der (psychiatrischen) Krankenpflege

Gewalt und Aggression stellen ein groses Risiko fur Patienten und Mitarbeitende im Gesundheitswesen dar. Dies gilt fur vielfaltige Settings und Fachgebiete. Immer dann, wenn Menschen sich in ihrer Freiheit eingeschrankt fuhlen, werden sie versuchen, die verlorengegangene Freiheit zuruckzuerlangen. Dies kann zu Konflikten und unterschiedlich gerichteter Gewalt innerhalb von Institutionen fuhren. Besonders intensiv hat sich die Psychiatrie mit dem Phanomen beschaftigt. In den letzten 50 Jahren hat sich in Deutschland die Situation in psychiatrischen Institutionen im Sinne der Patienten deutlich verbessert. So stehen heute der Autonomiegedanke der Patienten und partizipative Entscheidungsfindung als zentrale Elemente der psychiatrischen Behandlung fest. Hiermit gibt es eine Orientierung hin zur Teilhabe und personenorientierten Behandlung. Das Thema Gewalt ist trotz aller Veranderungen aktuell geblieben und stellt die Mitarbeitenden in solchen Einrichtungen vor grose Herausforderungen. Der Beitrag beschaftigt sich mit den Ursachen fur Gewalt in der Psychiatrie und gibt dann einen Uberblick uber Formen und Haufigkeiten. Anschliesend setzt er sich damit auseinander, wie Gewalt in der Psychiatrie reduziert oder verhindert werden kann.

Psychiatrische Notfälle und Krisensituationen

Fazit für die PflegePsychiatrische Notfallsituationen können heterogener Genese sein. Der Umgang mit diesen Notfall- und Krisensituationen braucht ein fachmännisches Vorgehen. Dies ist über Bildung, Berufserfahrung und Sensibilisierung für das Thema zu erreichen.Die für die Patienten sehr kritischen und eventuell vital bedrohenden Situationen brauchen ein berufsgruppenübergreifendes Vorgehen. Die an der Versorgung beteiligten Berufsgruppen sollten im Team arbeiten. Notfall- und Krisensituationen erfordern ein klares und abgestimmtes Vorgehen.Dem Patienten muss zu jedem Zeitpunkt Sicherheit vermittelt werden. Psychiatrische Notfallsituationen sind komplexe Versorgungssituationen für alle Beteiligten.