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Biomedical subjects

M Härter

Publications and source records attributed to M Härter.

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↗
PubMed2007

[Diagnostics and treatment of alcohol-related disorders: results of a representative study in psychiatric and psychotherapeutic practices].

BACKGROUND: Alcohol use disorders (AUD) are of high prevalence in the community. The aim of the present study is to examine the diagnostic and therapeutic strategies of psychiatrists and psychotherapists in patients with AUDs. METHODS: A standardized questionnaire was sent to all psychiatrists and psychologists in the South Badenia region (n = 745). It consisted of general questions and those regarding diagnostic and therapeutic procedures in the last patient seen with an AUD. A total of 224 questionnaires sent back by 160 psychotherapists [PT] and 64 psychiatrists [P] could be included in the analysis. RESULTS: The mean stated prevalence of AUDs was 5 %. The mean age of the reported patient was 44 +/- 10 years, 60 % were men. The initial reason for consultation in psychotherapy was in 61.9 % depression in comparison to 40.7 % psychiatry (p < or = 0,01). The majority of patients seen by psychiatrists (44.1 %) were referred by their general practitioners. Standardised screening instruments were rarely used. The concordance of the diagnostic judgement and formal ICD 10-criteria was 74.5 % [P] vs. 45.5 % [PT] (p </= 0,001). 60 % [P] and 24.1 % [PT] were referred to addiction counselling services (p < or = 0,001). Patient related factors were largely seen as major impediments for adequate diagnosis and treatment. DISCUSSION: The study demonstrates significant differences in the patient population and the diagnostic and therapeutic strategies in the two groups of therapists. Many aspects of the data point towards the need to improve networking and to integrate services to be able to provide better care for patients with AUDs.

Adult↗
PubMed2006

Development and first validation of the shared decision-making questionnaire (SDM-Q).

OBJECTIVE: Due to a lack of valid German instruments measuring shared decision-making (SDM), a theory-driven questionnaire (SDM-Q) to measure the process of SDM was developed and validated. METHODS: As a theoretical basis steps of the SDM process were defined in an expert panel. Item formulation was then conducted according to the Delphi method. For the first validation on a mixed sample Rasch analysis was used to eliminate items not fitting the construct thus receiving a unidimensional scale. RESULTS: After eliminating 4 items the remaining 11 form a unidimensional scale with an acceptable reliability for person measures (0.77) and very good reliability for item difficulties (0.95). Analysis of subgroups revealed a different use of items in different conditions. Furthermore the scale showed high ceiling effects. CONCLUSION: A new theory-driven instrument to measure the process of SDM has been developed and validated by use of a rigorous method revealing first promising results. Yet the ceiling effects require the addition of more discriminating items, and the different use of items in different conditions demands an in depth analysis. PRACTICE IMPLICATIONS: While the concept of SDM is constantly receiving more attention in medical practice, its valid and reliable measurement remains challenging.

Decision Making↗
PubMed2006

[Effects of a shared decision making model in psychiatric and neurologic practice].

Involving patients in medical decisions is increasingly being advocated in medical fields other than psychiatry and neurology. A model of shared decision making might prove to be an ideal way of bridging the gap between patient-centred and evidence-based medicine. This report provides a survey of this shared decision making model and a discussion of its implications in the fields of mental health and neurology.

Adaptation, Psychological↗
PubMed2006

[Distribution of pain parameters for chronic pain patients in comparison to the general population].

OBJECTIVE: The study analyzes pain complaints of chronic pain patients in comparison to representative data from the general population. METHODS: In a cross-sectional study 493 patients from different health care settings were interviewed about their pain during the previous 12-month and the currently strongest pain. Locations, frequency, intensity and duration of pain, restrictions in daily activities and utilization of therapies were assessed. For comparison data from the German federal health survey 1998 (n=6702) was used. RESULTS: The patients experienced pain more frequently and more severely than the general population. The largest difference was found in limitations of daily activities. Several qualitative similarities were observed, e.g. for the relative frequency of pain locations. Most patients reported multiple pain locations. The number of reported pain locations increased with intensity and duration of pain. Women reported more frequent and stronger pain than men, utilized more therapies and underwent more often alternative treatments. CONCLUSIONS: The high prevalence of pain complaints in both samples indicates the importance of early pain prevention, adequate diagnosis and treatment in order to obviate the development and chronification of pain.

Chronic Disease↗
PubMed2006

[Diagnostic and treatment approaches to alcohol-related disorders].

BACKGROUND: Due to their high prevalence alcohol related disorders (dependent, harmful and at risk drinking) are of major importance for the general practitioner (GP). The aim of this study was to examine the diagnostic and treatment strategies employed by the general practitioners. METHODS: A standardized 10-page questionnaire was mailed to a representative sample (n = 1232) of the general practitioners in south-west Germany. They were asked about diagnostic and therapeutic procedures they had employed in the last patient seen. Further questions regarded patient-related and structural problems. The response rate was 24.3 %. RESULTS: The reported patients had a mean age of 49 +/- 10.3 years. 70.6 % were of male sex. The mean duration of the last patient contact was 18.7 minutes. The diagnosis originated more in clinical impression than in use of screening instruments (0.7 % of patients) or formal diagnostic criteria. 76.7 % fulfilled ICD-10 criteria for dependent drinking, 65.0 % were judged dependent drinkers by the GP's. In most cases the patient had been referred to inpatient services. The main intervention (97.3 % of cases) was disease related counseling. 69.4 % were judged to be quite ill and severely ill. In most cases an inpatient referral had taken place. Pharmacotherapeutic measures were relatively rarely employed (11.3 %). As the major impediments of treatment patient related factors were stated (lack of acceptance of diagnosis, resistance to treatment). DISCUSSION: The majority of patients described by the GP's were dependent drinkers. This indicates that many at risk drinkers might perhaps not be correctly identified. Concerning therapeutic competency patient-related factors are considered as the major impediments for the delivery of effective care. This reflects a view of GP's that patients with alcohol problems are being difficult and time consuming. This should be carefully addressed by future GP-education programs.

Adult↗
PubMed2005

[Assessment of motivational changes in tinnitus sufferers. A study of the transtheoretical model].

OBJECTIVES: Cognitive-behavioural treatment of chronic tinnitus needs active cooperation and motivation in patients. The transtheoretical model (TTM) defines the behavioural change using six different stages of change (SoC). In this study, we examined SoC in patients with tinnitus via a new self-rating instrument. SAMPLE AND METHODS: An item-pool, consisting of 48 questions, was administered to 125 tinnitus sufferers in a cross-sectional study. In addition to data on tinnitus history, the tinnitus strain (THI, German: TB-12), scores of anxiety and depression (HADS-D), and life quality (SF-12) were assessed. RESULTS: Four SoC could be identified empirically: (1) precontemplation, (2) contemplation/preparation, (3) action/maintenance, and (4) termination. Associations of the SoC with socio-demographic and tinnitus related data, as well as with the instruments applied, conformed with the theory. CONCLUSIONS: The results confirm the transfer of SoC theory to patients with tinnitus.

Female↗
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↗
PubMed2005

[Guideline conformity and outcome of inpatient treatment for schizophrenia. A clinical comparison].

Patient outcome and guideline conformity in inpatient schizophrenia treatment was systematically evaluated and compared with 597 patients across seven psychiatric hospitals. Patient structure and treatment processes showed a great variability between hospitals. Patient characteristics, especially mental state, and the chronicity of the disease were the strongest predictors of clinical outcome. Outcome evaluation using quality indicators is only possible after case-mix adjustment taking into account prognostic factors. A poorer average clinical outcome was associated with lower guideline conformity in a variety of treatment domains. After case-mix adjustment, benchmarking is an opportunity to improve quality of treatment and promote guideline conformity.

Adult↗
PubMed2005

[Data supporting quality circle management of inpatient depression treatment].

BACKGROUND: Several quality assurance initiatives in health care have been undertaken during the past years. The next step consists of systematically combining single initiatives in order to built up a strategic quality management. METHODS: In a German multicenter study, the quality of inpatient depression treatment was measured in ten psychiatric hospitals. Half of the hospitals received comparative feedback on their individual results in comparison to the other hospitals (bench marking). Those bench markings were used by each hospital as a statistic basis for in-house quality work, to improve the quality of depression treatment. RESULTS: According to hospital differences concerning procedure and outcome, different goals were chosen. There were also differences with respect to structural characteristics, strategies, and outcome. The feedback from participants about data-based quality circles in general and the availability of bench-marking data was positive. The necessity of carefully choosing quality circle members and professional moderation became obvious. CONCLUSIONS: Data-based quality circles including bench-marking have proven to be useful for quality management in inpatient depression care.

Attitude of Health Personnel↗
PubMed2005

[Implementation and evaluation of a further-training measure on detection and diagnostics of mental disorders in medical rehabilitation].

The prevalence of comorbid mental disorders in rehabilitation patients is high. In spite of the biopsychosocial treatment approach in rehabilitation, recognition and treatment rates of comorbid mental disorders during medical rehabilitation are low. Therefore this study evaluates a special further-training measure for rehabilitation staff, intended to inform them about the relevance of comorbid mental disorders in rehabilitation patients, to train them in the use of screening instruments, and to discuss needed changes in rehabilitation processes. 14 further-training courses were carried out with 148 participants of different professions from rehabilitation hospitals. Interest in the training was rated to be high whereas previous knowledge of comorbid mental disorders was relatively low. The participants rated the basic conditions of the training as being good. Overall, the steps discussed to improve psycho-diagnostics in rehabilitation were rated as being important and realistic. Especially early recognition of mental burden, the use of screeners for detection, and the naming of diagnoses of mental disorders in discharge reports were considered as most readily realized. The results underline the importance of further-training for improving psycho-diagnostics in rehabilitation clinics, not only to ensure the biopsychosocial treatment approach in rehabilitation but also in view of reducing costs in the health care system.

Consumer Behavior↗
PubMed2004

[Goals and reality of quality circles in outpatient care in Germany].

In Germany's outpatient care, quality circles are strongly encouraged as a tool for peer review in order to implement quality assurance and management in daily practice. This paper presents an overview of the status of implementing quality circles in outpatient care. The main features of successful quality circles are described in terms of conditions, structures, and methodological approach. The objectives of quality circles are outlined, and it is discussed to which extent the quality circle concept is established. Recommendations for further developments of quality circles are drawn from this analysis.

Ambulatory Care↗
PubMed2004

[Development and validation of assessment instruments for shared decision making].

The German Ministry for Health and Social Security is funding ten projects to introduce shared decision making into clinical practice. The medical problems the projects are focussing on were chosen from among various diseases (e. g. depression, multiple sclerosis, cancer). The ten projects achieved consensus on a core set of instruments for the measurement of process and outcome of the shared decision making. Instruments developed in German-speaking countries are currently not available. Thus, linguistic and cultural validation had to be performed for the core set instruments. The results of the data analysis as well as patient interviews demonstrate the need for improving these instruments. Therefore, the members of the methodological working group concentrated on the integration of these results in a new instrument. In a first step the construct of "shared decision making" was defined, followed by a definition of the process elements characterising shared decision making. Thereafter, items were developed on the basis of the process elements. The new instrument will now be validated for different diseases.

Decision Making↗
PubMed2004

[Psychological stress and impaired quality of life in patients with tinnitus].

OBJECTIVES: The majority of patients with chronic decompensated forms of tinnitus have comorbid psychological disorders, possibly accompanied by restricted quality of life and participation in everyday activities. There is no standardized tool to measure these clinically relevant dimensions. SAMPLE AND METHOD: Both the Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 (SF-36) were administered to a consecutive sample of patients ( n=110) who were recruited from the tinnitus outpatient service in the department of psychiatry and psychotherapy. Using the Tinnitus Questionnaire (TF), associations of the HADS and SF-36 scales with tinnitus grading were determined and the classification of patients (mild-medium-severe-very severe) was evaluated. RESULTS: A severe tinnitus grading is correlated to a high extent of anxiety and depression and a low quality of life. With the exception of the SF-36 subscale on physical functioning, all scales discriminated between the extreme groups (mild vs severe/very severe), but less between the two medium groups. CONCLUSIONS: Patients with severe decompensated tinnitus (grades III and IV) should be seen for diagnosis of psychiatric comorbidity and supportive psychotherapy/psychopharmacotherapy used when necessary.

Activities of Daily Living↗
PubMed2004

[Psychiatric-psychotherapeutic inpatient treatment for depression. Process and outcome quality based on a model project in Baden-Wurttemberg].

During 1998-2000 a quality assurance program for diagnosis and treatment of depression was conducted in 24 hospitals for psychiatry and psychotherapy in Baden-Wurttemberg (southern Germany). Process and outcome quality of 3,000 depressive patients was documented at admission and discharge. The article focuses on therapeutic measures, duration, outcome, patient satisfaction, and their interactions. The results show that the patients' satisfaction with the care received is very high and the pre-post effect sizes of inpatient treatment for depression are high.

Adjustment Disorders↗
PubMed2004

[Relationship of depression and anxiety with social desirability in chronic pain patients].

OBJECTIVE: This study examines the extent of self-reported pain and psychological distress in chronic pain patients and the influence of social desirability on the data collected. METHODS: In a cross-sectional multi-center study with 494 chronic pain patients, a pain questionnaire was used similar to the German Federal Health Survey of 1998. Depression and anxiety were measured with the German version of the Hospital Anxiety and Depression Scale (HADS-D) and social desirability with the German Marlowe-Crowne short scale for the measurement of social desirability (KS-SE). RESULTS: Chronic pain patients reported stronger and more frequent pain, as well as higher psychological distress than the general population of Germany. Of the patients, 36.4% showed depression (HADS-D/D >or =9) and 31.4% anxiety (HADS-D/A > or =11). Depressed/anxious patients stated pain intensities higher than non-depressed/non-anxious patients. In all, 48.4% of the patients achieved social desirability levels in the marked or moderate range. There were positive correlations for social desirability with self-reported pain and the use of therapy, as well as age. A negative correlation was found between anxiety and social desirability, while for depression this interaction appeared only after partial correlation analysis with control of pain and therapy variables. CONCLUSIONS: Both psychological distress and social desirability are common in chronic pain patients. Patients with high scores for social desirability reveal less depression and anxiety. The psychological distress caused by pain seems to be expressed by somatic complaints and therapy seeking. Since pain research is strongly dependent on the patient's self-report, social desirability should be considered as a factor which may impact measurements and decisions.

Adult↗
PubMed2004

[Quality of guidelines for the treatment of alcohol related disorders -- a systematic review and content analysis].

BACKGROUND: Alcohol related disorders (dependent, harmful or at risk drinking) display a high prevalence in the community. We systematically reviewed and assessed the quality of available guidelines in the context of developing an evidence-based pathway of care for the treatment of those disorders in primary care. METHODS: We searched the internet for guidelines published in English, German, Italian, French or Spanish. The search was performed using the following sources: Internet Search engines, guideline providing agencies via internet, MEDLINE, PsychInfo and Cochrane Library. In addition, national professional societies were contacted to provide existing guidelines. We used a standardized instrument to assess methodological quality in three dimensions using dichotomous items: methodology of guideline development (21 items), content of guideline (17 items) and application (6 items). Each guideline was evaluated independently by two reviewers (MB, SH). Disagreement was documented using a disagreement protocol and resolved by discussion. Results were expressed as percent of total (domain) score. RESULTS: We included 9 published guidelines and 2 drafts. The methodological quality was heterogeneous. The mean quality score was below 50 % of the maximum score. Major flaws were lack of clear grounding in evidence-based medicine, too much information provided, lack of consumer involvement or insufficient involvement of all care providers as well as lack of implementation strategies. The scores of the guidelines published by professional societies for primary care were higher than the others. DISCUSSION: As demonstrated by the identified guidelines, more interdisciplinary panels and evidence-based processes need to be incorporated in the development process of guidelines for the treatment of alcohol related disorders. Our findings suggest that it might be advisable and effective to adapt already available valid and evidence-based guidelines or to collaborate with international working groups for the development of guidelines. There is a strong need for the scientific evaluation of implementation processes.

Alcoholism↗