Pfennig Andrea, Soltmann Bettina, Neumann Anne, Heinze Martin, Kliemt Roman, Häckl Dennis, Swart Enno, Baum Fabian, Ignatyev Yuri, Schwarz Julian, Kubat Denise, Weinhold Ines, Garcia Tarcyane Barata, von Peter Sebastian, Schmitt Jochen
Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany.
Center for Evidence-Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
Nervenarzt. 2025 Sep 18. doi: 10.1007/s00115-025-01896-6.
To overcome fragmented care provision in Germany, flexible, integrated psychiatric care (FIT) model projects according to § 64b of the German Social Code Book (SGB) V were implemented.
The results of the prospective cross-model, controlled, multiperspective/multimethod study PsychCare are presented and discussed along with data from statutory health insurance (SHI)-based research.
PsychCare applied a multi- and mixed-method design. Primary data were acquired in 18 psychiatric hospitals (n = 10 FIT; n = 8 matched treatment as usual-TAU) at study start (M-I) and 15 months later (M-II). Main outcomes were treatment satisfaction and health-related quality of life. Secondary outcomes included recovery, clinical decision-making, symptom severity, healthcare utilization and costs, needs and experiences with care, and caregiver burden. Participatory process evaluation assessed process-, structure-, and experience-related components.
Patients in FIT (n = 595) had significantly higher treatment satisfaction (ZUF-8: 26.3 ± 4.36 vs. 24.9 ± 4.70; p < 0.001) and recovery (RAS‑R total: 134 ± 35.8 vs. 119 ± 54.3; p < 0.001) at M‑I compared to TAU patients (n = 555), despite comparable symptom severity. About 50% of patients reported high satisfaction with clinical decision-making (p > 0.05); FIT caregivers were numerically more satisfied. Direct medical costs were significantly lower in FIT both at M‑I and M‑II. Type of care was associated with the degree of implementation of FIT components. Linking primary and SHI data was feasible.
PsychCare showed that FIT was superior in cross-sectional treatment satisfaction, recovery, and caregiver satisfaction with suggested cost-effectiveness. Long-term FIT success compared to standard care needs further assessment.
为克服德国医疗服务碎片化的问题，根据德国社会法典（SGB）第五卷第64b条实施了灵活的综合精神科护理（FIT）模式项目。
展示并讨论前瞻性跨模式、对照、多视角/多方法研究PsychCare的结果，并结合基于法定医疗保险（SHI）的研究数据进行分析。
PsychCare采用了多方法和混合方法设计。在研究开始时（M-I）和15个月后（M-II），从18家精神病医院收集了原始数据（n = 10家FIT模式医院；n = 8家匹配的常规治疗-TAU医院）。主要结局指标为治疗满意度和健康相关生活质量。次要结局指标包括康复情况、临床决策、症状严重程度、医疗服务利用和成本、护理需求和体验以及照护者负担。参与式过程评估对与过程、结构和体验相关的要素进行了评估。
与TAU患者（n = 555）相比，FIT模式下的患者（n = 595）在M-I时的治疗满意度显著更高（ZUF-8：26.3±4.36 vs. 24.9±4.70；p < 0.001），康复情况也更好（RAS-R总分：134±35.8 vs. 119±54.3；p < 0.001），尽管症状严重程度相当。约50%的患者对临床决策表示高度满意（p > 0.05）；FIT模式下的照护者在数量上更满意。FIT模式在M-I和M-II时的直接医疗成本均显著更低。护理类型与FIT模式各组成部分的实施程度相关。将初级数据和SHI数据相联系是可行的。
PsychCare研究表明，FIT模式在横断面治疗满意度、康复情况以及照护者满意度方面表现更优，且具有成本效益。与标准护理相比，FIT模式的长期成效有待进一步评估。
