Wedegärtner Felix, Wedegärtner Carolin, Müller-Thomsen Tomas, Bleich Stefan
Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Zentrum für seelische Gesundheit, Medizinische Hochschule Hannover, 30625 Hannover.
Psychiatr Prax. 2009 Oct;36(7):338-44. doi: 10.1055/s-0029-1220434. Epub 2009 Sep 28.
To elucidate the connections between individual aspects and patients' concerns and the care effort provided in a clinic for the sickest among outpatients.
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.
The linear regression model with the best fit (n = 251, r (2) = 0.512, p < 0.001) included six variables. Lower efforts: living in nursing home (beta = - 0.319; p < 0.001), higher age (beta = - 0.238; p < 0.001), legal incapacity (beta = - 0.165, p = 0.006), own work income (beta = - 0.100; p = 0.044); higher efforts: inpatient stays prior to study treatment (lifetime: beta = 0.181; p = 0.001; number of days in last two years: beta = 0.193; p < 0.001). Treatment aims, functional deficits, and diagnoses did not have a significant influence.
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.
阐明门诊最病重患者个体情况、患者关切与诊所所提供护理工作之间的联系。
对一家健康保险公司的客户在一家“综合门诊所”或“PIA”进行了为期六个月的跟踪研究（n = 339）。记录了所有治疗活动，这些活动大约涉及100,000个工作分钟。记录了社会人口统计学数据、诊断结果、个体需求和特质、症状及病史，用于多变量分析。
拟合度最佳的线性回归模型（n = 251，r² = 0.512，p < 0.001）包含六个变量。护理工作投入较低的因素：住在养老院（β = - 0.319；p < 0.001）、年龄较大（β = - 0.238；p < 0.001）、无行为能力（β = - 0.165，p = 0.006）、有自己的工作收入（β = - 0.100；p = 0.044）；护理工作投入较高的因素：研究治疗前的住院史（终生：β = 0.181；p = 0.001；过去两年的住院天数：β = 0.193；p < 0.001）。治疗目标、功能缺陷和诊断没有显著影响。
尽管患有严重精神疾病但希望独立生活的年轻患者可能会促使更高的治疗投入。养老院居民接受的治疗远没有那么复杂，尽管这些患者病情更重。当前的报销机制可能不利于根据个体需求进行护理管理。
