Incentives should be systematically set to encourage services that are specific for treating chronic disorders. Systematic incentive for the improvement of the outpatient depression care should be given for example in particular for the achievements, which are important for the care of chronic disorders.
Our findings only partly support the investigated AO intervention, because of conflicting results between clinician- and patient-ratings. Accordingly, the benefits of AO need to be further evaluated.
Active promotion of patient centered, community and trans-sectoral health care as proposed in integrated care models seem to foster sustainability of outpatient health care for demented individuals.
BackgroundA model of assertive outreach (AO) in which office-based psychiatrists collaborate with ambulatory nursing services for providing intensive home-treatment is currently being implemented in rural areas of Lower Saxony, Germany. The costs of the model are reimbursed by some of the statutory health insurance companies active in Lower Saxony. Effectiveness and efficiency of this model for patients suffering from schizophrenia is evaluated in a pragmatic and prospective trial.MethodsQuasi-experimental controlled trial: patients receiving the intervention are all those receiving AO; controls are patients not eligible for AO based on their health insurance affiliation. Eligibility criteria: clinical diagnosis of schizophrenia (ICD-10 F.20), aged at least 18 years and being moderately to severely impaired in global functioning. Primary outcome: admission and days spent in psychiatric inpatient care; secondary outcomes: clinical and functional status; patient satisfaction with chronic care; health care costs. Follow-up time: 6 and 12 months.DiscussionThe study faces many challenges typical to pragmatic trials such as the rejection of randomisation by service providers, the quality of treatment as usual (TAU) to which the intervention will be compared, and the impairment of the study subjects. Solutions of how to deal with these challenges are presented and discussed in detail.Trial registrationInternational Standard Randomised Controlled Trial Number:
http://ISRCTN34900108, German Clinical Trial Register:
http://DRKS00003351
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