Heddaeus Daniela, Dirmaier Jörg, Daubmann Anne, Grochtdreis Thomas, König Hans-Helmut, Löwe Bernd, Maehder Kerstin, Porzelt Sarah, Rosenkranz Moritz, Schäfer Ingo, Scherer Martin, Schulte Bernd, von dem Knesebeck Olaf, Wegscheider Karl, Weigel Angelika, Werner Silke, Zimmermann Thomas, Härter Martin
Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019 Feb;62(2):205-213. doi: 10.1007/s00103-018-2865-1.
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.
精神疾病的医疗保健对德国医疗体系而言是一项巨大挑战。对于患有共病性精神疾病的患者，其疾病负担尤为沉重。到目前为止，针对协作式和阶梯式护理的创新护理模式，仅就其对单一精神障碍的有效性进行了研究。由汉堡卫生服务研究网络（HAM-NET）于2017年至2020年开展的“通过克服治疗部门障碍实现精神卫生领域的协作式和阶梯式护理”（COMET）项目，考察了一种基于指南的创新医疗模式，以改善患有精神疾病及其潜在共病的患者的医疗保健状况。本文介绍了这种针对初级保健患者的新型阶梯式和协作式护理模式，该模式整合了全科医生、精神科医生、心理治疗师和医院。为了实施和推动该模式，开发了基于指南的治疗路径、一个用于筛查、诊断及基于指南的治疗建议的平板电脑应用程序，以及一个基于网络的转诊平台。该项目关于该模式有效性和效能的结果，有助于确定该模式能否在常规医疗保健中得以实施。这可能代表着朝着为精神疾病患者提供更综合、跨部门医疗保健迈出的重要一步。
