Härter Martin, Heddaeus Daniela, Steinmann Maya, Schreiber Robert, Brettschneider Christian, König Hans-Helmut, Watzke Birgit
Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland,
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015 Apr;58(4-5):420-9. doi: 10.1007/s00103-015-2124-7.
Depression is one of the most widespread mental disorders in Germany and causes a great suffering and involves high costs. Guidelines recommend stepped and interdisciplinary collaborative care models for the treatment of depression.
Stepped and collaborative care models are described regarding their efficacy and cost-effectiveness. A current model project within the Hamburg Network for Mental Health exemplifies how guideline-based stepped diagnostics and treatment incorporating innovative low-intensity interventions are implemented by a large network of health care professionals and clinics.
An accompanying evaluation using a cluster randomized controlled design assesses depressive symptom reduction and cost-effectiveness for patients treated within "Health Network Depression" ("Gesundheitsnetz Depression", a subproject of psychenet.de) compared with patients treated in routine care.
Over 90 partners from inpatient and outpatient treatment have been successfully involved in recruiting over 600 patients within the stepped care model. Communication in the network was greatly facilitated by the use of an innovative online tool for the supply and reservation of treatment capacities. The participating professionals profit from the improved infrastructure and the implementation of advanced training and quality circle work.
New treatment models can greatly improve the treatment of depression owing to their explicit reference to guidelines, the establishment of algorithms for diagnostics and treatment, the integration of practices and clinics, in addition to the implementation of low-intensity treatment alternatives. These models could promote the development of a disease management program for depression.
抑郁症是德国最普遍的精神障碍之一，造成巨大痛苦且成本高昂。指南推荐采用分阶段和跨学科协作护理模式治疗抑郁症。
描述分阶段和协作护理模式的疗效及成本效益。汉堡精神健康网络内的一个当前示范项目举例说明了由大量医疗保健专业人员和诊所实施的基于指南的分阶段诊断和治疗，其中纳入了创新性低强度干预措施。
采用整群随机对照设计进行的一项伴随评估，评估了在“健康网络抑郁症”（psychenet.de的一个子项目）中接受治疗的患者与接受常规护理的患者相比，抑郁症状减轻情况及成本效益。
来自住院和门诊治疗的90多个合作伙伴成功参与了在分阶段护理模式下招募600多名患者的工作。通过使用一种用于提供和预约治疗能力的创新在线工具，极大地促进了网络内的沟通。参与的专业人员受益于改善的基础设施以及高级培训和质量圈工作的实施。
新的治疗模式由于明确参照指南、建立诊断和治疗算法、整合医疗机构以及实施低强度治疗方案，能够极大地改善抑郁症的治疗。这些模式可以推动抑郁症疾病管理项目的发展。
