Biomedical subjects

H J Salize

Publications and source records attributed to H J Salize.

At least 19 recordsLinked to original sources

PubMed2007

[Cost predictors of depressive inpatient episodes in Germany. The health insurer's point of view].

BACKGROUND: Inpatient treatment is the most costly sector of treatment for depressive disorders in Germany. However, little is known about which patient and hospital characteristics contribute to costs of inpatient episodes. PATIENTS AND METHODS: To take part in this study, patients had to fullfill criteria for ICD-10 diagnosis of F31.3-F31.5, F32, F33, F34.1, F43.20, or F43.21. Episodes were recorded between September 9 2001 and March 3 2003 in ten hospitals in three German states. Inpatient records of 1,202 persons were analysed. Multiple regression analysis was performed to identify significant patient predictors of cost per inpatient episode, and the predictive function of hospital characteristics was analysed by applying hierarchical linear modeling. RESULTS: Patient characteristics at admission could not explain a substantial part of the variance in episode costs. Better prediction was possible including variables from the whole treatment process. Also, conditions for admission and patient-related factors did not well explain cost differences between hospitals, but characteristics of the whole treatment were. CONCLUSION: For predicting costs of inpatient depressive episodes, the complete course treatment has to be considered. As in the physiologic sector, therapeutic and diagnostic procedures have a great effect on cost prediction.

Adolescent↗

PubMed2006

[Threatened homelessness and mental disorders. Prevalence and influencing factors in populations at risk].

BACKGROUND: This study aims to assess the psychiatric morbidity of persons at risk of homelessness and to analyze correlations and risk factors between homelessness and mental disorders. METHODS: The sample included 101 citizens of Mannheim, Germany, who were immediately threatened by eviction. Mental disorders were diagnosed using a standardized test, and other factors were also assessed. Data from August 2000 to June 2002 were collected. RESULTS: Acute mental disorders requiring treatment were determined in 79.3% of the study sample. Addiction disorders (alcoholism) played a major role. Personality, anxiety, and affective disorders were even more frequent than in a control group of homeless people in the same region, whereas schizophrenia and other mental disorders were similarly prevalent. Regression analyses confirmed unemployment, alcoholism, and male gender as the most important risk factors for homelessness among people threatened by eviction. CONCLUSIONS: The results suggest that prevention strategies should be multidimensional and interdisciplinary.

Adult↗

PubMed2006

Forensic psychiatric assessment in European Union member states.

OBJECTIVE: To provide a structured description and cross-boundary comparison of legal frameworks and training standards relevant for forensic psychiatric assessment in European Union member states before the extension in May 2004. METHOD: Information on legislation and practice concerning the assessment of mentally disordered offenders was gathered by means of a detailed, structured questionnaire which was filled in by national experts. RESULTS: Legal frameworks for the assessment and reassessment of mentally disordered offenders and professional training standards in forensic psychiatry vary markedly across EU member states. CONCLUSION: Currently a cross-boundary harmonization of legal concepts appears hard to achieve. At least a formal construction and implementation of specialist training standards in forensic psychiatry would appear desirable.

Crime↗

PubMed2005

[Are bonus systems applicable to guideline-oriented depression treatment provided by general practitioners and neurologists?].

In the outpatient treatment of depression, the potential of diagnostic and therapeutic methods is seldom exhausted resulting in variable quality of treatment and partly insufficient cost effectiveness. Implementation of a guideline-oriented reimbursement system seems to be an option to improve quality of treatment. Corresponding incentive systems have been outlined and evaluated for the health care of somatic diseases such as diabetes. Acting on these experiences, an attempt was made to utilize them for the area of psychiatric disorders. Taking depression as an example, a model for a quality-oriented, guideline-based reimbursement system for general and specialist practice is presented.

Ambulatory Care↗

PubMed2004

[Is there an increase in the number of compulsory admissions of mentally ill patients in European Union Member States?].

PURPOSE: In a study subsidized by the European Commission, the course of compulsory admission rates (admissions per 100,000 population) and compulsory admission quotas (proportion of annual compulsory admissions of all admissions to psychiatric inpatient treatment) of mentally ill patients from 15 European member states was analysed. METHOD: Information was gathered by means of a detailed questionnaire filled in by experts from all EU-Member States. RESULTS: Compulsory admission rates and compulsory admission quotas differ significantly across the EU member states. Compulsory admission rates range from 6 (Portugal) to 218 (Finland) per 100,000 population and compulsory admission quotas vary from 3.2 % (Portugal) to 30 % (Sweden). In some member states a significant increase of compulsory admission rates was detected without a significant increase of compulsory admission quotas. CONCLUSION: The relatively steady compulsory admission quotas suggest no real increase of coercion regarding admission to psychiatric inpatient care. Increasing compulsory admission rates rather reflect changing overall patterns of providing psychiatric service, tending towards decreased length of hospital stays, and more frequent readmissions.

Austria↗

PubMed2001

Needs for mental health care and service provision in single homeless people.

BACKGROUND: Specific problems in sampling methodology, case-finding strategies and a standardised needs assessment in mentally ill homeless people have contributed to their being neglected as a mental health care clientele. METHOD: We assessed a representative sample of homeless people (n=102) in the highly industrialised city of Mannheim (Germany) regarding their prevalence of mental disorders (using the SCID) and their needs for mental health care (using the NCA). RESULTS: We found high prevalences, with 68.6% of all assessed homeless persons having a current mental disorder. Thus, needs for mental health care were very common, with unmet needs predominating in all problem areas, which was supported by a very weak service utilization. Thus, even in a region with a comprehensive community mental health care network, like the study area, mentally ill homeless people are widely under-provided. CONCLUSIONS: Results suggest that the traditional shelter system for homeless people carries most of the mental health care burden for their clientele and must be supported by adequate interventions from community-based mental health care services. A closer connection of both sectors and a better co-ordination of the care offers seems to be a prerequisite for helping to reduce unmet mental health care needs in this specific high-risk group.

Adolescent↗

PubMed2001

[How do mentally ill homeless persons evaluate their quality of life].

Besides pronounced deficiencies in psychiatric research concerning homeless mentally ill in Germany, studies concerned with the quality of life of homeless mentally ill were missing until now. This study reveals in a representative sample of 102 homeless people from the City of Mannheim, Germany that--compared to the homeless without psychiatric disorders of the sample--the mentally ill homeless (prevalence 68.6%) have significantly different subjective views of their quality of life regarding the items "state of health", "physical capabilities" and "support from others". The differences were even stronger if the homeless mentally ill were compared to a group of non-homeless mentally ill schizophrenic patients (n = 104), cared for in the City's well-equipped community care services. Community care patients reported a significantly better quality of life in respect of 11 items. These results were seen as a success of the concept of community-based mental health care. The consequences for improving care strategies for homeless mentally ill are discussed.

Activities of Daily Living↗

PubMed2001

[Costs of schizophrenia - what we know (not)?].

Schizophrenia is regarded as one of the most expensive mental illnesses because of its specific symptoms and characteristics. The care of schizophrenic patients consumed approx. 2 % of the total German health care expenditures in 1994, according to the scarce data provided by routine German health reporting. Despite this enormous impact, health-economical research in schizophrenia in Germany is widely neglected. While few empirical studies on direct cost of care for schizophrenic patients suggest that adequate comprehensive community care in Germany during the mid-nineties was about DM 27 000 to DM 28 000 per patient and year, there is a serious lackage of cost-effectiveness-studies, relating cost of care to outcome. Thus, the most basic data for any health care planning in schizophrenia is missing. This paper reviews the studies on cost of schizophrenia in Germany. It identifies the most serious knowledge gaps and describes the obstacles for an adequate research in this field.

Community Mental Health Services↗

PubMed2000

[Quality assurance and documentation for community mental health services cooperative (GPV). A standardized procedure for regional health care documentation and planning].

This paper describes a standardized assessment-procedure for the so-called "Gemeindepsychiatrische Verbünde" in Germany (GPV-Documentation), which are regional combines of community-based mental health care services. It is the first procedure in Germany which puts data on psychiatric care offers, needs for care and service utilization of all sectors and services in community-based mental health care into standardized measures, thus making offers and care of these services comparable. The procedure can be applied to the daily routine of catchment areas. From a methodical point of view the GPV-Documentation keeps a functional approach to community-based mental health care, but additionally it enables services to describe their specific contribution to regional care separately from others. Annual follow-ups make the GPV-Documentation an ideal tool for planning purposes, care management and quality assurance. Cross-regional comparisons of standards of care are possible. The implementation will also enhance the quality of governmental health reports on the care of chronically mentally ill in Germany remarkably.

Community Mental Health Services↗

PubMed1999

[Is there a disproportional increase in health care costs for schizophrenic patients?].

Empirical data on costs of care for chronically mentally ill patients in Germany are rare. There is a lack of cross-sectional studies as well as of any analysis of the long-term course of mental health care costs. This study combines data from two cost-studies on patients with schizophrenia, conducted in the same catchment area at an interval of 15 years, to draw conclusions about the long-term course of these costs. The direct costs of comprehensive community based mental health care had increased by 77.0% during 15 years, while the costs of a permanent stay in a long-term ward of a psychiatric hospital had increased by 78.5% in the same period. This increase was 27 and 28.5 per cent higher than the general rise in cost of living in Germany during the interval between the two studies. This higher-than-average increase in mental health care costs was accompanied by a much higher cost-effectiveness. Thus, this rise of costs must be seen as a consequence of the great deficits and the resulting basic improvement of care for chronically mentally ill patients in Germany, which was demanded by an expert-commission of the government in the mid-seventies.

Community Mental Health Services↗

PubMed1999

Does the place of treatment influence the quality of life of schizophrenics?

OBJECTIVE: Chronically mentally ill patients in community mental health care report a better quality of life (QOL) than those in long-term hospital care, which suggests that the treatment setting per se influences their QOL. METHOD: In a region where both treatment settings are of a comparable high standard, we assessed the QOL of 96 schizophrenic patients from these two treatment settings, and the factors which most influenced their QOL. RESULTS: Community-care patients reported a better QOL than long-term hospital-care patients. However, when other factors influencing QOL were included in a regression analysis, the place of treatment was no longer significant, but rather the social support, the severity of the illness, educational level and certain illness concepts. CONCLUSION: It is probably not the place per se which influences the QOL, but apart from personal, sociodemographic and illness-related factors, the amount of social support that is provided in different settings.

Adult↗

PubMed1999

Needs for care and effectiveness of mental health care provision for schizophrenic patients in two European regions: a comparison between Granada (Spain) and Mannheim (Germany).

OBJECTIVE: The aims of this study were to develop an indicator for comparing the effectiveness of community mental health care across different areas, and to compare the effectiveness of care for schizophrenic patients in two European regions. METHOD: In a long-term follow-up, service utilization, needs for care and met needs of schizophrenic patients were assessed. An indicator of effectiveness of care was calculated for each region and compared. RESULTS: Patients in Mannheim received much more intervention in all types of mental health care. Despite differing utilization patterns, the indicator of effectiveness of care revealed no differences in the area of symptoms and behaviour problems between the two regions, while significant differences in the area of skills and abilities of patients were detected. CONCLUSION: We succeeded in defining a measure that describes effectiveness of mental health care in terms of the long-term relationship between needs and unmet needs of patients. Our results contribute to an evidence-based discussion of the improvement of community mental health care networks.

Adult↗

PubMed1997

Costing community care.

Explore the source record for details and available documents.

Community Mental Health Services↗

PubMed1996

[The attitude of medical students to psychiatric patients].

Numerous studies conducted during the past decades indicate that the public's attitude toward the mentally ill is strongly prejudiced. Since the attitude of the general public also has an effect on community-based psychiatric care, we must ask how public opinion might be influenced. One possible approach could be through so called key community leaders--those who are highly respected in society because of their competence in a particular area. Doctors belong to this group of people. For this reason we questioned medical students, as future key community leaders, with respect to their attitudes toward the mentally ill within the framework of their first contact with psychiatric patients during their studies. In order to make a direct comparison possible, we interviewed a sample of the Mannheim population who live in a part of the city where a variety of complementary facilities have been set up. The comparison shows that medical students do not have a more positive attitude toward the mentally ill; in fact, in certain areas they have an even more negative attitude toward the mentally ill than the general population has. We were not able to establish what effect teaching has with respect to changing attitudes.

Adolescent↗

PubMed1996

The cost of comprehensive care of people with schizophrenia living in the community. A cost evaluation from a German catchment area.

BACKGROUND: In community mental health care, knowledge about costs of care is very limited. Only few studies have related costs to outcome measures. METHOD: This German study assesses the cost of psychiatric care of 66 schizophrenic patients during one year of living in the community. Predictors of high cost were identified. RESULTS: The average cost of comprehensive community care of one patient of the cohort was US$ 363 per week. This was only 43% of the cost of constant long-term care in a psychiatric hospital. Significant predictors of total cost of community care were the number of rehabilitative problems at the beginning and at the end of the study period, the type of accommodation before index hospitalisation and the gender of patients. CONCLUSIONS: Results must be understood in terms of the characteristics of the special patient group and the catchment area we studied and are of high relevance in planning future care.

Activities of Daily Living↗

PubMed1996

[Psychiatric departments in general hospitals--developmental status in Germany].

Departments of Psychiatry in Germany were approached by direct investigations via a questionnaire regarding various parameters of structure and performance during 1993, since only insufficient administrative data on the structure of inpatient care were available. An expert inquiry that had been officially conducted in Germany in 1975 had recommended for 200 beds for inpatient accommodation. The present investigation, however, revealed that the average number of beds was only 80 in almost all hospitals. The majority of the Departments approached were engaged in 100% patient care, so that the discussion regarding two classes of psychiatry in respect of impatient nursing care is now obsolete. There is also no significant difference between the Departments of Psychiatry in hospitals in the pre-reunification West German and East German areas, the only exception being the sizes and hence the capacities of the relevant departments.

Forecasting↗

PubMed1996

[Voluntary aids in psychiatry].

Lay helpers fill in in situations where the natural system of help-family and friends-can no longer cope or where professional help is also not able to offer adequate help. Since no representative studies on this group of people exist, we wanted to take stock of the current situation by conducting a questionnaire in Baden-Württemberg. We identified 891 lay helpers in psychiatric facilities, of which 330 (37%) took part in the survey. The results of the study point out that lay help is the domain of older women. Their main duties are to give support through conversation and leisure activities. Although many lay helpers have been active over a long period of time, most of them express a high level of satisfaction with their occupation. A higher level of satisfaction is shown among those lay helpers who receive a certain amount of professional support in their work.

Aged↗

PubMed1996

[Cost assessment in a fragmented psychiatric treatment system].

While Anglo-American countries increasingly integrate cost-effectiveness-studies into mental health care, in Germany there is still a basic need for empirical data with regard to the cost of care for the mentally ill. This study assesses the total cost of community mental health care of 66 schizophrenic patients prospectively over the course of 12 months. The comprehensive community care of the patients proved to be 43% of the cost of long-term treatment in a state mental hospital. Rehabilitative need, as well as living conditions and gender, showed significant influence on the total cost of community care.

Adolescent↗