Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246, Hamburg, Germany.
Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
BMC Psychiatry. 2018 Oct 25;18(1):347. doi: 10.1186/s12888-018-1914-5.
German statutory health insurances are pursuing the goal of improving treatment of chronically ill people by promoting networks of health care providers and supporting treatments that reflect the current medical knowledge. The so-called PNP program is a collaborative care program developed by a German statutory health insurance, which defines specific rules on psychiatric, neurological, psychosomatic, and psychotherapeutic treatment. It aims to strengthen provision of guideline-based outpatient treatment and collaboration between different health care providers. It includes the general practitioners' program, which aims to strengthen the coordinating role of GPs. This study aims to evaluate the PNP program.
To evaluate the effectiveness of the PNP program, we will conduct a prospective non-randomized controlled trial with primary data comparing patients enrolled in the PNP program and in the general practitioner program (intervention group) to patients enrolled only in the general practitioner program and patients who receive usual care (control groups). To evaluate costs and level of detail of diagnoses in care of patients with PNP program, we will use routinely collected secondary administrative health data in a retrospective quasi-experimental design. Patients who are at least 18 years old, insured by the statutory health insurance AOK, and on sick leave due to one of the mental or neurological diagnoses (affective, anxiety, somatoform or adjustment disorders, alcohol use disorders, schizophrenia, multiple sclerosis) will be included. We will collect data at baseline and at 12-months follow-up. Health-related quality of life (primary data) and direct costs (secondary data) caused by outpatient and inpatient service utilization and medication will be the primary outcomes. We will analyze data using (generalized) linear mixed models and exploratory analyses. We will use entropy balancing to control for possible differences between the groups. We will use an exploratory sequential design including qualitative and descriptive statistical analyses to assess the structure and process quality of the PNP program among health care providers.
The results will help to develop a comprehensive picture of collaborative care programs for mental and neurological health care from the perspective of patients, health care providers, and health insurance companies.
German Clinical Trial Register DRKS00013114.
德国法定健康保险旨在通过促进医疗服务提供者网络并支持反映当前医学知识的治疗方法来改善慢性病患者的治疗效果。所谓的 PNP 计划是德国法定健康保险制定的一种协作护理计划，它对精神科、神经科、身心科和心理治疗规定了具体规则。该计划旨在加强基于指南的门诊治疗，并加强不同医疗服务提供者之间的合作。它包括全科医生计划，旨在加强全科医生的协调作用。本研究旨在评估 PNP 计划。
为了评估 PNP 计划的效果，我们将进行一项前瞻性非随机对照试验，使用初级数据比较参加 PNP 计划和全科医生计划（干预组）的患者与仅参加全科医生计划和接受常规护理的患者（对照组）。为了评估 PNP 计划中患者护理的成本和诊断详细程度，我们将在回顾性准实验设计中使用常规收集的二级行政健康数据。纳入标准为年龄至少 18 岁、受法定健康保险 AOK 承保、因精神或神经诊断（情感、焦虑、躯体形式或适应障碍、酒精使用障碍、精神分裂症、多发性硬化症）而休病假的患者。我们将在基线和 12 个月随访时收集数据。健康相关生活质量（初级数据）和门诊和住院服务利用以及药物引起的直接成本（二级数据）将作为主要结果。我们将使用（广义）线性混合模型和探索性分析来分析数据。我们将使用熵平衡来控制组间可能存在的差异。我们将使用探索性序贯设计，包括定性和描述性统计分析，来评估医疗服务提供者中 PNP 计划的结构和过程质量。
结果将有助于从患者、医疗服务提供者和健康保险公司的角度全面了解精神和神经保健协作护理计划。
德国临床试验注册处 DRKS00013114。
