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Erprobung eines integrierten und gestuften Behandlungsmodells für psychische Störungen und Komorbiditäten im Hamburger Netzwerk für Versorgungsforschung

Clinical trial of a stepped and collaborative care model for mental illnesses and comorbidities in the Hamburg Network for Health Services Research

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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Die Versorgung psychischer Störungen stellt eine große Herausforderung für das deutsche Gesundheitssystem dar. Wenn Mehrfachdiagnosen vorliegen, leiden die Betroffenen unter einer besonders hohen Krankheitslast. Innovative Behandlungsmodelle für eine integrierte und gestufte Versorgung (Collaborative Care und Stepped Care) sind bisher nur hinsichtlich ihrer Wirksamkeit für singuläre Störungsbilder untersucht worden.

Das Projekt „Integrierte und gestufte Versorgung psychischer Erkrankungen durch Überwindung sektoraler Behandlungsbarrieren“ (COMET), welches vom Hamburger Netzwerk für Versorgungsforschung (HAM-NET) von 2017 bis 2020 durchgeführt wird, untersucht ein innovatives, leitlinienorientiertes Versorgungsmodell zur Verbesserung der Versorgung von Menschen mit psychischen Störungen unter Einbezug möglicher Komorbiditäten. Dieses neue Stepped- und Collaborative-Care-Modell für Patienten der Primärversorgung, das Hausärzte, Psychiater und Psychotherapeuten sowie Kliniken vernetzt, wird im vorliegenden Beitrag vorgestellt. Zur Implementierung und Förderung des Modells wurden leitliniengerechte Behandlungspfade, ein tabletgestütztes Programm für Screening, Diagnostik und leitliniengerechte Behandlungsempfehlungen sowie eine webbasierte Terminvergabeplattform entwickelt.

Die aus dem Projekt gewonnenen Erkenntnisse zur Effektivität und Effizienz des Modells können die Entscheidung, ob das Modell zukünftig in die Gesundheitsversorgung übertragen wird, unterstützen. Damit könnte ein entscheidender Fortschritt im Hinblick auf eine stärker integrierte und sektorenübergreifende Versorgung von Patienten mit psychischen Störungen gelingen.

Abstract

Healthcare for mental disorders is a big challenge for the German healthcare system. In cases of comorbid mental diseases, patients suffer from an especially high burden of disease. So far, innovative care models for collaborative and stepped care have only been investigated with respect to their effectiveness for single mental disorders.

The project “Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers” (COMET), which is being carried out by the Hamburg Network for Health Services Research (HAM-NET) from 2017 until 2020, examines an innovative, guideline-based healthcare model for the improvement of healthcare for patients with mental illnesses and their potential comorbidities. In this article this new stepped and collaborative care model for patients in primary care that integrates general practitioners, psychiatrists, psychotherapists, and hospitals is presented. For the implementation and facilitation of the model, guideline-based treatment pathways, a tablet-based computer program for screening, diagnostic and guideline-based treatment recommendations, as well as a web-based transferal platform were developed.

The results of this project on the effectiveness and efficacy of the model can help determine if the model can be implemented in routine healthcare. This could represent a major step towards more integrated and cross-sectoral healthcare for patients with mental illnesses.

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Authors and Affiliations

  1. Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Daniela Heddaeus, Jörg Dirmaier &  Martin Härter

  2. Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Anne Daubmann & Karl Wegscheider

  3. Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Thomas Grochtdreis & Hans-Helmut König

  4. Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Bernd Löwe, Kerstin Maehder & Angelika Weigel

  5. Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Sarah Porzelt, Martin Scherer &  Thomas Zimmermann

  6. Zentrum für interdisziplinäre Suchtforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Moritz Rosenkranz, Ingo Schäfer & Bernd Schulte

  7. Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    Olaf von dem Knesebeck & Silke Werner

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  1. Daniela Heddaeus
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Correspondence to Martin Härter.

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Interessenkonflikt

D. Heddaeus, J. Dirmaier, A. Daubmann, T. Grochtdreis, H.-H. König, B. Löwe, K. Maehder, S. Porzelt, M. Rosenkranz, I. Schäfer, M. Scherer, B. Schulte, O. von dem Knesebeck, K. Wegscheider, A. Weigel, S. Werner, T. Zimmermann und M. Härter geben an, dass kein Interessenkonflikt besteht.

Das beschriebene Projekt „Integrierte und gestufte Versorgung psychischer Erkrankungen durch Überwindung sektoraler Behandlungsbarrieren (COMET)“ wurde von der Ethikkommission der Ärztekammer Hamburg begutachtet (Bearbeitungsnummer PV5595 am 08.09.2017) und wird mit deren Zustimmung durchgeführt. Die Studie ist bei www.clinicaltrials.gov registriert (ClinicalTrials.gov ID: NCT03226743). Das Projekt wird unter dem Förderkennzeichen 01GY1602 vom BMBF gefördert.

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Heddaeus, D., Dirmaier, J., Daubmann, A. et al. Erprobung eines integrierten und gestuften Behandlungsmodells für psychische Störungen und Komorbiditäten im Hamburger Netzwerk für Versorgungsforschung. Bundesgesundheitsbl 62, 205–213 (2019). https://doi.org/10.1007/s00103-018-2865-1

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