The specific pattern of neuropsychological deficits of the alcoholic patients supports the frontal lobe hypothesis. The results of the present investigation suggest that these deficits are not generally exacerbated by comorbid depressive symptoms. Further studies, however, are desirable to investigate the relation between executive deficits and depression in alcoholics with evidence of major depression.
In the present study the costs of schizophrenia in Germany were studied using the "bottom up" prevalence-based method. In a random sample of 180 schizophrenic patients stratified according to the most important care institutions, direct and indirect costs were retrospectively documented for a 12-month period. Depending on the place of recruitment and the extent of care provided, total yearly costs result between about DM 33,000 for a patient treated predominantly on an outpatient basis and about DM 126,000 for a patient requiring hospital care and about DM 135,000 for a patient in job rehabilitation. The direct yearly treatment costs were, as expected, lowest for patients recruited in the private practice of a psychiatrist and predominantly treated on an outpatient basis (DM 5,788), and were the highest in the psychiatric hospital (DM 64,661) and in job rehabilitation (DM 79,996). In the patients recruited in the outpatient domain, doctors' fees and medication together were responsible for only 4.5% of the total costs, whereas the indirect costs (e.g., through work incapacity) were responsible for 87% of the total yearly costs. For methodological reasons the total costs caused by schizophrenic psychoses in Germany per year can at present be estimated only roughly. A conservative estimate is between 8.5 and 18 billion DM per year. The study shows that schizophrenia is a very expensive illness, the direct and indirect costs of which are on the whole comparable to those of the common somatic illnesses. Therefore, also for economical reasons, sufficient financial means should be invested in the research and treatment of this severe illness.
It is possible to integrate routine assessment of patient satisfaction into quality management.
Zusammenfassung. Bei der Messung der Prozess- und Ergebnisqualität in Einrichtungen des Gesundheitswesens ergeben sich eine Reihe besonderer Probleme, die eine einfache Übertragung von Qualitätskennzahlen aus anderen Wirtschaftsbereichen erschweren. So müssen die unterschiedlichen Anforderungen verschiedener Anspruchsgruppen wie z.B. von Patienten. Krankenkassen und staatlichen Institutionen abgebildet werden. Im vorgestellten Projekt wurde auf zwei Stationen einer psychiatrischen Klinik erfolgreich erprobt, ob das Managementsystem PPM ( Pritchard, Kleinbeck & Schmidt, 1993 ) als Instrument der Qualitätsmessung im Gesundheitswesen geeignet ist. Es zeigte sich, dass vor allem die bei der Entwicklung eines PPM-Systems geforderte Klärung und präzise Definition von gemeinsamen Aufgaben und Leistungsstandards einer aus verschiedenen Berufsgruppen (u.a. Ärzte, Pfleger / Schwestern und Sozialarbeiter) zusammengesetzten Arbeitsgruppe einer Station von den Betroffenen als hilfreich erlebt wird. Entgegen vielfach geäußerter Zweifel war es möglich, hinreichend inhaltsvalide und für die Mitarbeiter anwendungsfreundliche Messgrößen zur Qualitätsmessung zu entwickeln. Es zeigte sich auch, dass die Entwicklung und Anwendung von Leistungsmesssystemen entsprechend der PPM-Systematik den Betroffenen hilft. Probleme der internen Arbeitsorganisation festzustellen und - ggf. mit externer Begleitung - zu beseitigen. Weiterhin wird die Ausweitung des Projekts über interne Multiplikatoren beschrieben.
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