Paulzen M, Müller A, Akkus T, Bergmann F, Schneider F
Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland,
Nervenarzt. 2014 Jul;85(7):856-64. doi: 10.1007/s00115-013-3914-5.
According to the special report of the Advisory Council on the Assessment of Developments in the Health Care Sector, the termination of contracts on integrated care (IC) in accordance with §140a-d of the Social Act V (SGB V) was mostly due to high costs and volume expansion by services providers (physicians). However, there is still limited knowledge about the medical and economic impact of projects of integrated care, as such projects were on the one hand not primarily designed with a scientific evaluation in mind and on the other hand health insurance agencies usually do not evaluate data for scientific reasons.
In Aachen the IC project "Integrated Care in Mental Health" ran between 2006 and 2011. During that time a total of 3,408 patients with depressive disorders were treated across institutional and trans-sectoral borders according to the national clinical practice guidelines and S3 guidelines on unipolar depression. This study was initiated in an attempt to describe and evaluate the clinical success of treatment.
This study evaluated the outcome of the clinical treatment provided but due to the lack of available data on the economic impact of the project, the study contribution is limited to non-economic aspects. By comparing various clinical parameters it could be shown that scores in certain patient-reported clinical scales, such as the Hamilton rating scale for depression, and the WHO-5 well-being index as well as on the clinician-reported clinical global impression (CGI) improved in a statistically significant manner over time compared to initial assessments. Due to the lack of data on an appropriate comparison cohort of patients any comparative statements concerning the superiority of the treatment of depressive disorders outside an integrated care project remains hypothetical and preliminary.
This study revealed the limitations of a naturalistic study in an IC setting and showed that without adequate funding a satisfactory evaluation that fulfills scientific criteria seems to be impossible.
根据医疗保健部门发展评估咨询委员会的特别报告，依据《社会法典第五编》（SGB V）第140a - d条终止综合护理（IC）合同，主要原因是服务提供者（医生）成本高昂且业务量扩张。然而，对于综合护理项目的医学和经济影响，人们了解仍然有限，一方面此类项目最初并非主要为科学评估而设计，另一方面医疗保险机构通常出于科学原因不评估数据。
在亚琛，“心理健康综合护理”IC项目于2006年至2011年开展。在此期间，根据国家临床实践指南和关于单相抑郁症的S3指南，共有3408名抑郁症患者接受了跨机构和跨部门的治疗。本研究旨在描述和评估治疗的临床效果。
本研究评估了所提供临床治疗的结果，但由于缺乏该项目经济影响的可用数据，研究贡献仅限于非经济方面。通过比较各种临床参数可以发现，与初始评估相比，某些患者报告的临床量表得分，如汉密尔顿抑郁量表、世界卫生组织-5幸福指数以及临床医生报告的临床总体印象（CGI）随时间有统计学意义的改善。由于缺乏关于适当对照患者队列的数据，任何关于综合护理项目外抑郁症治疗优越性的比较性陈述仍属假设且初步。
本研究揭示了IC环境下自然主义研究的局限性，并表明没有足够资金，似乎不可能进行符合科学标准的令人满意的评估。
