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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2018.00785

Evaluation of flexible and integrative psychiatric treatment models in Germany – a mixed-method, patient and staff-oriented, exploratory study.

 Sebastian von Peter1, 2*,  Yuriy Ignatyev1, 2, Sonja Indefrey3,  Jakob Johne4*, Onur A. Kankaya3, Burkhard Rehr1, 2,  Manfred Zeipert1, 2, Andreas Bechdolf3, 5, 6, Thomas Birkner7, Arno Deister8,  Annette Duve9,  Sandeep Rout10, Harald Scherk9, Anna Schulz-Dubois11, Bettina Wilms12, Dyrk Zedlick13, Bernard Braun14, Jürgen Timm15,  Martin Heinze1, 2 and Peter Grollich1
  • 1Immanuel Klinik Rüdersdorf, Germany
  • 2Medizinische Hochschule Brandenburg Theodor Fontane, Germany
  • 3Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Germany
  • 4Charité Medical University of Berlin, Germany
  • 5Vivantes Klinikum, Germany
  • 6Universität zu Köln, Germany
  • 7Westküstenklinikum, Germany
  • 8Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Germany
  • 9Vitos Klinikum Riedstadt, Germany
  • 10Vivantes Klinikum Neukölln, Germany
  • 11Imland Klinik Rendsburg, Germany
  • 12Carl-von-Basedow-Klinikum Saalekreis gGmbH, Germany
  • 13Rudolf Virchow Klinikum Glauchau, Germany
  • 14Research Center for Inequality and Social Policy, Faculty of Business Studies and Economics, University of Bremen, Germany
  • 15University of Bremen, Germany

Contrary to the practice in some countries, access to flexible and integrated forms of psychiatric care (FIT models) is limited in Germany. Several legislations have been introduced to improve this situation, notably the recent §64b (flexible and integrative treatment model; FIT64b) of the German Social Code, which allows for a capitation-based accounting of fees for services. The aim of this study was to explore the effects of FIT64b implementation on various stakeholders (patients, informal caregivers and staff) in 12 psychiatry departments across Germany. Structural as well as quantitative and qualitative data were included, with integration of different methodological approaches. In all departments, the implementation of the new accounting system resulted into a relatively stable set of structural and processual changes: Rigid forms of mainly inpatient care shifted to more flexible and integrated types of outpatient and outreach treatments. These changes were more likely to be perceived, and received better evaluations, by both patients and staff in those departments showing higher level or longer duration of implementation. Patients’ evaluations, furthermore, were largely influenced by the advent of continuous forms of care, better accessibility, and by their degree of autonomy in steering of services.

Keywords: implementation, cross sectoral mental health care, user evaluation, Staff evaluation, mixed method, Regional budget

Received: 03 Oct 2018; Accepted: 31 Dec 2018.

Edited by:

Helen Schmidt, Psychiatric University Hospital Zurich, Switzerland

Reviewed by:

Andres R. Schneeberger, Albert Einstein College of Medicine, United States
Arlette S. Bär Deucher, University of Zurich, Switzerland  

Copyright: © 2018 von Peter, Ignatyev, Indefrey, Johne, Kankaya, Rehr, Zeipert, Bechdolf, Birkner, Deister, Duve, Rout, Scherk, Schulz-Dubois, Wilms, Zedlick, Braun, Timm, Heinze and Grollich. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Dr. Sebastian von Peter, Immanuel Klinik Rüdersdorf, Rüdersdorf, 15562, Berlin, Germany,
Mr. Jakob Johne, Charité Medical University of Berlin, Berlin, Germany,