RESUMEN
BACKGROUND: German statutory health insurances are pursuing the goal of improving treatment of chronically ill people by promoting networks of health care providers and supporting treatments that reflect the current medical knowledge. The so-called PNP program is a collaborative care program developed by a German statutory health insurance, which defines specific rules on psychiatric, neurological, psychosomatic, and psychotherapeutic treatment. It aims to strengthen provision of guideline-based outpatient treatment and collaboration between different health care providers. It includes the general practitioners' program, which aims to strengthen the coordinating role of GPs. This study aims to evaluate the PNP program. METHODS: To evaluate the effectiveness of the PNP program, we will conduct a prospective non-randomized controlled trial with primary data comparing patients enrolled in the PNP program and in the general practitioner program (intervention group) to patients enrolled only in the general practitioner program and patients who receive usual care (control groups). To evaluate costs and level of detail of diagnoses in care of patients with PNP program, we will use routinely collected secondary administrative health data in a retrospective quasi-experimental design. Patients who are at least 18 years old, insured by the statutory health insurance AOK, and on sick leave due to one of the mental or neurological diagnoses (affective, anxiety, somatoform or adjustment disorders, alcohol use disorders, schizophrenia, multiple sclerosis) will be included. We will collect data at baseline and at 12-months follow-up. Health-related quality of life (primary data) and direct costs (secondary data) caused by outpatient and inpatient service utilization and medication will be the primary outcomes. We will analyze data using (generalized) linear mixed models and exploratory analyses. We will use entropy balancing to control for possible differences between the groups. We will use an exploratory sequential design including qualitative and descriptive statistical analyses to assess the structure and process quality of the PNP program among health care providers. DISCUSSION: The results will help to develop a comprehensive picture of collaborative care programs for mental and neurological health care from the perspective of patients, health care providers, and health insurance companies. TRIAL REGISTRATION: German Clinical Trial Register DRKS00013114.
Asunto(s)
Atención Ambulatoria/métodos , Medicina General/métodos , Trastornos Mentales/terapia , Servicios de Salud Mental , Enfermedades del Sistema Nervioso/terapia , Adolescente , Adulto , Enfermedad Crónica , Femenino , Alemania , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Seguro de Salud , Colaboración Intersectorial , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados no Aleatorios como Asunto , Evaluación de Programas y Proyectos de Salud/métodos , Estudios Prospectivos , Calidad de Vida , Proyectos de Investigación , Estudios Retrospectivos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Background In 2015 a survey was conducted in Baden-Württemberg (Germany) among patients treated by orthopaedic specialists participating in a medical specialists' contract between doctors and statutory health insurance funds, in accordance with § 73c of the German Social Code, Book V (SGB V). This contract aims to improve orthopaedic care by structured cooperation between orthopaedic specialists and general practitioners, who are the central coordinators of care, and refer patients to a specialist if necessary. The program is intended to achieve patient-centred care by taking into account the physical, psychological and social aspects of the patients' orthopaedic complaints, as well as informing and motivating patients for self-management and health promoting activities. The survey was intended to receive feedback on the quality of care from the patients enrolled in this medical specialists' program, particularly concerning the specific aims of the program. A feedback report with individual results and a comparison with the overall results of all participating medical practices was sent out to those practices that provided at least 20 analysable questionnaires. Material and Methods The anonymous survey was conducted using a questionnaire specifically developed for the project. Participating practices handed out questionnaires to up to 100 patients who were enrolled in the program and consulted their orthopaedic or surgical specialist within 3 months of the start of the survey. Completed questionnaires were collected and sent to the research institute for data analysis in a sealed box. Results A total of 10,010 patients from 267 practices took part in the survey. Data analysis (including an anonymous comparison of the results of participating practices) was conducted on the basis of patients' responses from 183 practices that had obtained at least 20 completed questionnaires (8,988 patients, response rate 49.1%). Survey results are presented on doctor-patient communication, scheduling appointments, waiting times, cooperation with general practitioner, referral and treatment. On the whole, patients were satisfied with the care provided by their orthopaedic or surgical specialist. The comparison between the practices revealed significant differences in the patients' sociodemographic features and their feedback on the medical care received. Patients' evaluation of information and the counselling received from their orthopaedic/surgical specialist showed the strongest correlation with overall satisfaction. Referral by their general practitioner had a positive influence on patients' intentions to consult their orthopaedic/surgical specialist again. From the patients' point of view, doctors' information and counselling on self-help activities (e.g. eating habits, physical activity) had the largest potential for improvement. Conclusions The survey's results confirm the objectives of this new orthopaedic health care program, especially motivational counselling on adequate physical activity and self-management. They provide a basis for the further development of the quality of care, in accordance with both the contractual aims and the patients' needs.