Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Vivantes Klinikum Am Urban, Berlin, Germany.
Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany.
BMC Psychiatry. 2021 Mar 30;21(1):173. doi: 10.1186/s12888-021-03163-9.
BACKGROUND: Over the last decades, many high-income countries have successfully implemented assertive outreach mental health services for acute care. Despite evidence that these services entail several benefits for service users, Germany has lagged behind and has been slow in implementing outreach services. In 2018, a new law enabled national mental health care providers to implement team-based crisis intervention services on a regular basis, allowing for different forms of Inpatient Equivalent Home Treatment (IEHT). IEHT is similar to the internationally known Home Treatment or Crisis Resolution Teams. It provides acute psychiatric treatment at the user's home, similar to inpatient hospital treatment in terms of content, flexibility, and complexity. METHODS/DESIGN: The presented naturalistic, quasi-experimental cohort study will evaluate IEHT in ten hospitals running IEHT services in different German regions. Within a multi-method research approach, it will evaluate stakeholders' experiences of care, service use, efficacy, costs, treatment processes and implementation processes of IEHT from different perspectives. Quantitative surveys will be used to recruit 360 service users. Subsequently, 180 service users receiving IEHT will be compared with 180 matched statistical 'twins' receiving standard inpatient treatment. Assessments will take place at baseline as well as after 6 and 12 months. The primary outcome is the hospital re-admission rate within 12 months. Secondary outcomes include the combined readmission rate, total number of inpatient hospital days, treatment discontinuation rate, quality of life, psycho-social functioning, job integration, recovery, satisfaction with care, shared decision-making, and treatment costs. Additionally, the study will assess the burden of care and satisfaction with care among relatives or informal caregivers. A collaborative research team made up of researchers with and without lived experience of mental distress will conduct qualitative investigations with service users, caregivers and IEHT staff teams to explore critical ingredients and interactions between implementation processes, treatment processes, and outcomes from a stakeholder perspective. DISCUSSION: By integrating outcome, process and implementation research as well as different stakeholder perspectives and experiences in one study, this trial captures the various facets of IEHT as a special form of home treatment. Therefore, it allows for an adequate, comprehensive evaluation on different levels of this complex intervention. TRIAL REGISTRATION: Trial registrations: 1) German Clinical Trials Register (DRKS), DRKS000224769. Registered December 3rd 2020, https://www.drks.de/drks_web/setLocale_EN.do ; 2) ClinicalTrials.gov, Identifier: NCT0474550 . Registered February 9th 2021.
背景:在过去几十年中,许多高收入国家已经成功地为急性护理实施了积极的外展精神卫生服务。尽管有证据表明这些服务对服务使用者有多项益处,但德国却落后了,并且在外展服务的实施方面进展缓慢。2018 年,一项新法律使国家精神卫生服务提供者能够定期实施基于团队的危机干预服务,从而提供不同形式的住院等效家庭治疗(IEHT)。IEHT 类似于国际知名的家庭治疗或危机解决小组。它在用户家中提供急性精神病治疗,在内容、灵活性和复杂性方面与住院医院治疗相似。 方法/设计:本研究是一项自然主义、准实验性队列研究,将评估在德国不同地区运行 IEHT 服务的十家医院中的 IEHT。在多方法研究方法中,它将从不同角度评估利益相关者对护理、服务使用、疗效、成本、治疗过程和 IEHT 实施过程的体验。将使用定量调查来招募 360 名服务使用者。随后,将比较 180 名接受 IEHT 的服务使用者与 180 名接受标准住院治疗的匹配统计“双胞胎”。评估将在基线以及 6 个月和 12 个月时进行。主要结果是 12 个月内的医院再入院率。次要结果包括联合再入院率、总住院天数、治疗中断率、生活质量、心理社会功能、工作融入、康复、护理满意度、共同决策以及治疗成本。此外,该研究还将评估护理负担和亲属或非正式照顾者对护理的满意度。由具有和没有精神困扰生活经验的研究人员组成的合作研究团队将对服务使用者、照顾者和 IEHT 工作人员团队进行定性研究,从利益相关者的角度探索实施过程、治疗过程和结果之间的关键因素和相互作用。 讨论:通过将结果、过程和实施研究以及不同利益相关者的观点和经验整合到一项研究中,该试验从特殊的家庭治疗形式的角度捕捉了 IEHT 的各种方面。因此,它允许对这种复杂干预措施的不同层面进行充分、全面的评估。 试验注册:试验注册:1)德国临床试验注册处(DRKS),DRKS000224769。于 2020 年 12 月 3 日注册,https://www.drks.de/drks_web/setLocale_EN.do;2)ClinicalTrials.gov,标识符:NCT0474550。于 2021 年 2 月 9 日注册。
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