University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Hospital Rüdersdorf, Rüdersdorf, Germany.
Centre for Health Services Research, Brandenburg Medical School, Rüdersdorf, Germany.
BMC Psychiatry. 2022 Dec 26;22(1):826. doi: 10.1186/s12888-022-04477-y.
BACKGROUND: Internationally, intensive psychiatric home treatment has been increasingly implemented as a community-based alternative to inpatient admission. Since 2018, the so-called Inpatient Equivalent Home Treatment (IEHT; German: "Stationsäquivalente Behandlung", short: "StäB") has been introduced as a particularly intensive form of home treatment that provides at least one daily treatment contact in the service users' (SU) home environment. Prior research shows that this can be challenging in rural catchment areas. Our paper investigates to which extent the location of the SU home location within the catchment area as well as the distance between the home and the clinic influence the utilisation of inpatient treatment compared to IEHT. METHOD: Routine data of one psychiatric hospital in the federal state of Brandenburg in Germany were analysed for the observational period 07/2018-06/2021. Two comparison groups were formed: SU receiving inpatient treatment and SU receiving IEHT. The SU places of residence were respectively anonymised and converted into geo-coordinates. A geographic information system (GIS) was used to visualise the places of residence, and car travel distances as well as travel times to the clinic were determined. Spatial analyses were performed to show the differences between comparison groups. In a more in-depth analysis, the proximity of SU residences to each other was examined as an indicator of possible clustering. RESULTS: During the observational period, the location of 687 inpatient and 140 IEHT unique SU were mapped using the GIS. SU receiving treatment resided predominantly within the catchment area, and this proportion was slightly higher for SU receiving IEHT than for those treated in inpatient setting (95.3% vs. 84.7%). In the catchment area, the geographical distribution of SU place of residence was similar in the two groups. There was a general higher service provision in the more densely populated communities close to Berlin. SU with residence in peripheral communities were mainly treated within the inpatient setting. The mean travel times and distances to the place of residence only differed minimally between the two groups of SU (p > 0.05). The places of residence of SU treated with IEHT were located in greater proximity to each other than those of SU treated in inpatient setting (p < 0.1). CONCLUSION: In especially peripheral parts of the examined catchment area, it may be more difficult to have access to IEHT rather than to inpatient services. The results raise questions regarding health equity and the planning of health care services and have important implications for the further development of intensive home treatment. Telehealth interventions such as blended-care approaches and an increase of flexibility in treatment intensity, e.g. eliminating the daily visit requirement, could ease the implementation of intensive home treatment especially in rural areas.
背景:在国际上,强化精神科家庭治疗已作为住院治疗的替代方案,在社区层面上得到越来越多的应用。自 2018 年以来,所谓的“住院等效家庭治疗”(德语:"Stationsäquivalente Behandlung",简称"StäB")已被引入,作为一种特别强化的家庭治疗形式,它在服务使用者(SU)的家庭环境中提供至少每天一次的治疗接触。先前的研究表明,在农村集水区,这可能具有挑战性。我们的论文调查了 SU 家庭住址在集水区内的位置以及家庭与诊所之间的距离对住院治疗与 IEHT 治疗的利用程度的影响。 方法:对德国勃兰登堡州一家精神病院的观察期 07/2018-06/2021 内的常规数据进行了分析。形成了两个对照组:接受住院治疗的 SU 和接受 IEHT 治疗的 SU。SU 的居住地点分别匿名,并转换为地理坐标。使用地理信息系统(GIS)对居住地点进行可视化,并确定到诊所的汽车旅行距离和旅行时间。进行空间分析以显示对照组之间的差异。在更深入的分析中,检查了 SU 住所之间的接近程度,作为可能聚类的指标。 结果:在观察期内,使用 GIS 对 687 名住院和 140 名 IEHT 独特 SU 的位置进行了映射。接受治疗的 SU 主要居住在集水区内,而接受 IEHT 治疗的 SU 的比例略高于接受住院治疗的 SU(95.3%对 84.7%)。在集水区内,SU 居住地点的地理位置分布在两组之间相似。在离柏林较近、人口密度较大的社区中,服务提供总体上更高。位于偏远社区的 SU 主要接受住院治疗。SU 接受 IEHT 治疗的平均旅行时间和距离与住院治疗的 SU 组仅略有差异(p>0.05)。IEHT 治疗的 SU 的居住地点彼此之间的距离比接受住院治疗的 SU 的居住地点更近(p<0.1)。 结论:在被检查的集水区的特别偏远地区,获得 IEHT 治疗可能比获得住院服务更困难。结果引发了关于健康公平和医疗服务规划的问题,并对强化家庭治疗的进一步发展具有重要意义。远程医疗干预措施,如混合保健方法和增加治疗强度的灵活性,例如消除每天访问的要求,可能会特别在农村地区更容易实施强化家庭治疗。
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