从住院治疗到门诊治疗在抑郁症中的转变面临的挑战。
Challenges in the Transition from In-Patient to Out-Patient Treatment in Depression.
机构信息
Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
Department of Medicine and Health Services Research, BARMER Statutory Health Insurance Fund, Wuppertal, Germany.
出版信息
Dtsch Arztebl Int. 2020 Jul 6;117(27-28):472-479. doi: 10.3238/arztebl.2020.0472.
BACKGROUND
Few data are available on the characteristics of inpatient treatment and subsequent outpatient treatment for depression in Germany. In this study, we aimed to characterize the inpatient and outpatient treatment phases, to determine the rates of readmission and mortality, and to identify risk factors.
METHODS
We carried out a descriptive statistical analysis of routine administrative data from a large health-insurance carrier (BARMER). All insurees aged 18 to 65 who were treated in 2015 as inpatients on a psychiatry and psychotherapy service or on a psychosomatic medicine and psychotherapy service with a main diagnosis of depression were included in the analysis. Risk factors for readmission and death were determined with the aid of mixed logistic regression.
RESULTS
Of the 22 893 patients whose data were analyzed, 78% had been hospitalized on a psychiatry and psychotherapy service and 22% on a psychosomatic medicine and psychotherapy service. The median length of hospital stay was 42 days. Follow-up care in the outpatient setting failed to conform with the recommendations of the pertinent guidelines in 92% of the patients with a main diagnosis of severe depression during hospitalization, and in 50% of those with moderate depression. 21% of the patients were readmitted within a year. The mortality at one year was 961 per 100 000 individuals (adjusted for the age and sex structure of the German population), or 3.4 times the mortality of the population at large. In the regression model, more treatment units during hospitalization and subsequent treatment with psychotherapy were associated with a lower probability of readmission, while longer hospitalization with subsequent pharmacotherapy or psychotherapy was associated with lower mortality.
CONCLUSION
The recommendations of the national (German) S3 guidelines for the further care of patients who have been hospitalized for depression are inadequately implemented at present in the sectored structures of in- and outpatient care in the German health care system. This patient group has marked excess mortality.
背景
关于德国抑郁症患者住院治疗和随后门诊治疗的特点，相关数据较少。本研究旨在描述住院和门诊治疗阶段，确定再入院率和死亡率，并确定风险因素。
方法
我们对一家大型健康保险公司（BARMER）的常规管理数据进行了描述性统计分析。所有年龄在 18 至 65 岁之间的被保险人在 2015 年因抑郁症入住精神病学和心理治疗服务或身心医学和心理治疗服务的主要诊断住院，都纳入了分析。使用混合逻辑回归确定再入院和死亡的风险因素。
结果
在所分析的 22893 名患者中，78%的患者在精神病学和心理治疗服务部门住院，22%的患者在身心医学和心理治疗服务部门住院。住院中位数为 42 天。在住院期间主要诊断为严重抑郁症的 92%的患者和中度抑郁症的 50%的患者在门诊随访中未按照相关指南的建议进行治疗。一年内有 21%的患者再次入院。一年的死亡率为每 10 万人中有 961 人（根据德国人口的年龄和性别结构调整），是一般人群死亡率的 3.4 倍。在回归模型中，住院期间接受更多的治疗单位和随后接受心理治疗与再入院的可能性降低相关，而随后接受药物治疗或心理治疗的住院时间延长与死亡率降低相关。
结论
目前，德国卫生保健系统的门诊和住院治疗部门在实施国家（德国）S3 指南关于抑郁症患者进一步治疗的建议方面做得不够，这一患者群体的死亡率明显偏高。
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