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Innovative Versorgungsmodelle für Menschen mit schizophrenen Erkrankungen

  • Martin LambertEmail author
  • Vivien Kraft
  • Anja Rohenkohl
  • Friederike Ruppelt
  • Romy Schröter
  • Daniel Lüdecke
  • Birgit Linschmann
  • Simon Eich
  • Lisa Tlach
  • Despina Lion
  • Susann Bargel
  • Martin Hoff
  • Gunda Ohm
  • Michael Schulte-Markwort
  • Daniel Schöttle
  • Hans-Helmut König
  • Holger Schulz
  • Judith Peth
  • Jürgen Gallinat
  • Anne Karow
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Zusammenfassung

Schizophrenie ist eine sehr komplexe psychische Erkrankung. Sie stellt das Versorgungssystem vor enorme strukturelle, therapeutische und gesundheitsökonomische Herausforderungen. Innovative Versorgungsmodelle für Schizophrenie können helfen, die Behandlung effektiver und effizienter zu machen.

Das Ziel dieser Arbeit ist es, eine Übersicht zu evidenzbasierten und innovativen Versorgungs- und Behandlungsmodellen für Schizophrenie und schwere psychische Erkrankungen zu geben. Dazu erfolgte eine Literaturrecherche bezüglich Publikationen zu „Versorgungs- oder Behandlungsmodellen“ und „Schizophrenie“, „Psychosen“, „schweren psychischen Erkrankung“ der letzten 10 Jahre.

Viele Publikationen informieren nicht oder nur wenig detailliert über das jeweils erprobte Versorgungsmodell. Innovative Versorgungsmodelle für Schizophrenie umfassen Early Psychosis Services (EPS) oder Modelle für schwere psychische Erkrankungen, in denen die Behandlungsmodelle Crisis Resolution Team (CRT), Assertive Community Treatment (ACT) und/oder (Intensive) Case Management (ICM) integriert, kombiniert und/oder weiterentwickelt wurden. Exemplarisch erläuterte innovative Modelle sind das Early Psychosis Prevention and Intervention Centre (EPPIC) in Australien, das Flexible-Assertive-Community-Treatment-Modell in den Niederlanden und das Therapeutische Assertive-Community-Treatment-Modell in Hamburg. Alle drei bieten eine regelhaft integrierte, spezialisierte und aufsuchend-nachgehende Versorgung.

Der Umsetzungstand innovativer Versorgungsmodelle in Deutschland ist unzureichend, weder EPS noch ACT gehören zur Regelversorgung, CRT ist nun mit der stationsäquivalenten Behandlung nach §§ 39 und 115d (SGB V) finanzierbar. Bezüglich der integrierten Implementierung von CRT und ACT in Deutschland läuft aktuell eine klinische Studie zum sog. RECOVER-Modell. Dabei handelt es sich um ein schweregradgestuftes und sektorenübergreifend koordiniertes Versorgungsmodell, dessen Erprobung durch den Innovationsfonds beim Gemeinsamen Bundesausschuss (G-BA) von 2017 bis 2020 gefördert wird.

Schlüsselwörter

Versorgungsmodelle Integrierte Versorgung Schizophrenie Bipolare Störung Schwere psychische Erkrankung 

Innovative care models for people with schizophrenia

Abstract

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.

Keywords

Care models Integrated care Schizophrenia Bipolar disorder Severe mental illness 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Lambert weist auf folgende Beziehungen hin: Studien (AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Sanofi Aventis), Beratung (AstraZeneca, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH, Roche Deutschland Holding GmbH, Trommsdorff GmbH & Co. KG) und Vorträge (AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH, Roche Deutschland Holding GmbH, Sanofi Aventis). V. Kraft, A. Rohenkohl, F. Ruppelt, R. Schröter, D. Lüdecke, B. Linschmann, S. Eich, L. Tlach, D. Lion, S. Bargel, M. Hoff, G. Ohm, M. Schulte-Markwort, D. Schöttle, H.-H. König, H. Schulz, J. Peth, J. Gallinat und A. Karow geben an, dass keine Interessenkonflikte bestehen.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Martin Lambert
    • 1
    Email author
  • Vivien Kraft
    • 1
  • Anja Rohenkohl
    • 1
  • Friederike Ruppelt
    • 1
  • Romy Schröter
    • 1
  • Daniel Lüdecke
    • 1
  • Birgit Linschmann
    • 1
  • Simon Eich
    • 1
  • Lisa Tlach
    • 1
  • Despina Lion
    • 1
  • Susann Bargel
    • 2
  • Martin Hoff
    • 2
  • Gunda Ohm
    • 2
  • Michael Schulte-Markwort
    • 3
  • Daniel Schöttle
    • 1
  • Hans-Helmut König
    • 4
  • Holger Schulz
    • 5
  • Judith Peth
    • 5
  • Jürgen Gallinat
    • 1
  • Anne Karow
    • 1
  1. 1.Kompetenzzentrum für Integrierte Versorgung psychischer Erkrankungen, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale MedizinUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland
  2. 2.Strategische UnternehmensentwicklungUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland
  3. 3.Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -PsychotherapieUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland
  4. 4.Institut für Gesundheitsökonomie und VersorgungsforschungUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland
  5. 5.Stiftungslehrstuhl Klinische VersorgungsforschungUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland

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