Disease-Management und Versorgungsintegration bei Depressionen: Gibt es Evidenz für eine Beeinflussung des Krankheitsverlaufes,der Lebensqualität und der Inanspruchnahme des Gesundheitswesens?

Abstract

Disease management and integrated health care for depression: Is there evidence for effects on the course of disease, quality of life, and utilization patterns?

Depression is one of the most common diseases world-wide associated with high societal costs and reduced quality of life. New approaches in health care delivery such as integrated care or disease management programs (DMP) aim at compensating major care deficits, but evidence regarding the actually achieved benefits for Germany is still lacking. This paper gives an overview on two recently performed studies focussing both approaches.

The first study provides an evaluation of DMP for the treatment of depression. A meta-analysis has been performed including 10 RCT. Findings suggest that quality of care in terms of ‘depression severity', ‘patient satisfaction', and ‘implementation of guideline driven care’ can be enhanced by comprehensive DMP. Health related quality of life was analysed in only 4 of 10 RCT showing heterogeneous results.

The other study compares primary care patients with psychological problems in a gate keeper system (the Netherlands) and in an open access system (Germany). The gate keeper system restrains utilization of care in terms of physician contacts and intensity of treatment, while at the same time part of specialist treatment is transfered to inpatient services. The question remains unanswered whether, in contrast to the expected advantages of integrated health care concepts, this does not indicate inadequate ambulatory care.