Lambert Martin, Kraft Vivien, Rohenkohl Anja, Ruppelt Friederike, Schröter Romy, Lüdecke Daniel, Linschmann Birgit, Eich Simon, Tlach Lisa, Lion Despina, Bargel Susann, Hoff Martin, Ohm Gunda, Schulte-Markwort Michael, Schöttle Daniel, König Hans-Helmut, Schulz Holger, Peth Judith, Gallinat Jürgen, Karow Anne
Kompetenzzentrum für Integrierte Versorgung psychischer Erkrankungen, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
Strategische Unternehmensentwicklung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2019 Feb;62(2):163-172. doi: 10.1007/s00103-018-2868-y.
Schizophrenia is a complex mental disorder. Hence, the mental health system faces enormous structural, therapeutic, and health-economic challenges. Innovative models of healthcare can facilitate making treatment more efficient and effective.This paper aims to give an overview of evidence-based and innovative models of care and treatment for schizophrenia and severe mental illnesses. For this purpose, we performed a literature search covering the last 10 years of publications regarding "care or treatment models" and "schizophrenia," "psychosis," or "severe mental illness."Many publications do not provide details about the tested care model. Innovative care models for schizophrenia comprise early psychosis services (EPSs) or models for severe mental illnesses (SMI) integrating, combining and/or developing the treatment models crisis resolution team (CRT), assertive community treatment (ACT), and/or (intensive) case management (ICM). For illustration, the innovative models Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia, the Flexible Assertive Community Treatment model in the Netherlands, and the Therapeutic Assertive Community Treatment model in Hamburg are explained. All three models regularly offer integrated, specialized, and assertive care.In Germany, innovative models of care have not been implemented sufficiently: neither EPS nor ACT are part of standard care; CRT can now be funded by health insurances via "ward-equivalent treatment" as defined by a new German law (§§ 39 und 115d SGB V). Regarding the implementation of CRT and ACT in Germany, a clinical study evaluating the RECOVER model is underway. This is a stepped-care, trans-sectorally coordinated and evidence-based treatment model, the evaluation of which is supported by the innovation fund of the Joint Federal Committee (Gemeinsamen Bundesausschuss, G‑BA) from 2017 to 2020.
精神分裂症是一种复杂的精神障碍。因此，心理健康系统面临着巨大的结构、治疗和健康经济挑战。创新的医疗模式有助于提高治疗的效率和效果。本文旨在概述基于证据的精神分裂症及严重精神疾病的创新护理和治疗模式。为此，我们进行了一项文献检索，涵盖了过去10年中有关“护理或治疗模式”以及“精神分裂症”“精神病”或“严重精神疾病”的出版物。许多出版物未提供所测试护理模式的详细信息。精神分裂症的创新护理模式包括早期精神病服务（EPS）或严重精神疾病（SMI）模式，这些模式整合、组合和/或发展了危机解决团队（CRT）、积极社区治疗（ACT）和/或（强化）个案管理（ICM）的治疗模式。例如，对澳大利亚的早期精神病预防和干预中心（EPPIC）、荷兰的灵活积极社区治疗模式以及汉堡的治疗性积极社区治疗模式进行了解释。这三种模式都定期提供综合、专业和积极的护理。在德国，创新护理模式尚未得到充分实施：EPS和ACT都不是标准护理的一部分；CRT现在可以由医疗保险根据德国一项新法律（《社会法典》第五编第39条和第115d条）规定的“病房等效治疗”进行资助。关于CRT和ACT在德国的实施情况，一项评估RECOVER模式的临床研究正在进行中。这是一种分阶段护理、跨部门协调且基于证据的治疗模式，其评估在2017年至2020年期间得到了联邦联合委员会（Gemeinsamen Bundesausschuss，G-BA）创新基金的支持。
