Home Treatment – aufsuchende Behandlung im Hamburger Modell der Integrierten Versorgung

Zusammenfassung

Aufsuchende Behandlungsformen, wie das „Crisis Resolution and Home Treatment (CRHT)“ oder „Assertive Community Treatment“ (ACT), haben sich als effektive und die Behandlungsqualität verbessernde Modelle zur Behandlung von Menschen mit schweren psychischen Erkrankungen erwiesen. In Deutschland sind diese noch wenig implementiert, als Bestandteil einer sektorenübergreifenden Integrierten Versorgung jedoch vereinzelt vorhanden. Anhand des Hamburger Modells wird dargestellt, wie die Umsetzung einer solchen Behandlung durch ein ACT-Team als Teil der Integrierten Versorgung (IV) aussehen kann und anhand der Ergebnisse des 3-Jahres-Verlaufs diskutiert. Das Hamburger Modell bezeichnet ein IV-Modell für schwer erkrankte Psychose-Patienten. Das Modell wird seit 2007 als Managed Care „Capitation-Modell“ über den §140 SGB V als Jahrespauschale von verschiedenen Krankenkassen finanziert und kontinuierlich bezüglich der Effektivität und Effizienz untersucht. In Vorstudien zu diesem Modell zeigte sich bereits bei Kostenneutralität im Vergleich zur Standardbehandlung eine niedrige Gesamtbehandlungsabbruchrate sowie signifikante Verbesserungen hinsichtlich Psychopathologie, Funktionsstatus, Lebensqualität, Therapieadhärenz und Behandlungszufriedenheit. Auch die Rate von Zwangseinweisungen verringerte sich signifikant auf 10% im Vergleich zu den Vorjahren. 2011 wurde das Modell im Rahmen einer vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Studie (Integrated Care in Early Psychosis, ICEP-Studie) auf die Indikation „ersterkrankte Jugendliche und junge Erwachsene im Alter von 12 bis 29 Jahren“ spezifiziert. Diesbezüglich wurde ein fachübergreifendes Team implementiert. Dieses Projekt wird seit 2012 von den beteiligten Krankenkassen gemäß einer Erweiterung des §140 SGB V finanziert.

Abstract

Treatment models like “Crisis Resolution and Hometreatment (CRHT)” or “Assertive Community Treatment” (ACT), were found to be effective, enhancing the qualitative level of treatment for patients with severe mental disorders. In Germany, these are implemented only sporadically until today, often as part of a cross-sectoral Integrated Care (IC) treatment system. We will present the implementation of an “Assertive Community Treatment” embedded into an IC-treatment model in Hamburg and discuss the 3-year-outcomes. The IC-treatment model has been designed for severe mentally ill patients with psychotic disorders. Since May 2007 the model is financed by different health insurances as a managed-care “capitation-model” and its effectiveness gets continuously evaluated. The model proved to be effective in earlier studies were compared with standard care low rates of service disengagement were found as well as significantly improved psychopathology, psychosocial functioning, quality of life, satisfaction with care and adherence, while being cost effective. The rates of involuntary admissions declined to 10% in comparison to the years before. In 2011 the model was specified to the indication “first-episode adolescents and young adults in the age of 12–29” in a government-funded study “Integrated Care in Early Psychosis, ICEP Study”. In this study an interdisciplinary team of child, adolescent and adult psychiatrists was implemented and since 2012 it is financed by the involved health insurances throughout an expansion of the §140 SGB V agreement.

Schlüsselwörter

Assertive Community Treatment - Psychose - schwere psychische Erkrankung

Keywords

assertive community treatment - psychosis - severe mental illness

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