Gesundheitswesen 2018; 80(01): 34-39
DOI: 10.1055/s-0042-107344
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Zeit für Veränderung – Was wir für die hausärztliche Versorgung älterer depressiver Menschen von den USA lernen können

Time for Change: What We can Learn from the USA about Primary Care of the Depressed Elderly
F. Bjerregaard
1   Klinik für Psychiatrie und Psychotherapie, Uniklinik Freiburg, Freiburg
,
M. Hüll
2   Klinik für Geronto- und Neuropsychiatrie, Zentrum für Psychiatrie und Psychotherapie Emmendingen, Emmendingen
,
R.-D. Stieglitz
3   Fakultät für Psychologie, Abteilung klinische Psychologie und Psychiatrie, Universität Basel, Basel, Switzerland
,
L. P. Hölzel
1   Klinik für Psychiatrie und Psychotherapie, Uniklinik Freiburg, Freiburg
› Author Affiliations
Further Information

Publication History

Publication Date:
26 September 2016 (online)

Zusammenfassung

Depression ist eine der häufigsten psychischen Erkrankungen im höheren Lebensalter. Oft geht sie mit komorbiden somatischen Erkrankungen einher und Betroffene werden zu Vielnutzern des Gesundheitssystems. Aufgrund der nicht nur individuellen, sondern auch gesellschaftlichen Relevanz, ist ein Blick auf die aktuelle Versorgung und Optimierungsmöglichkeiten von älteren Menschen mit Depression wichtig und notwendig. Der Hausarzt stellt meist nicht nur die erste Anlaufstelle dar, sondern übernimmt oft die gesamte Depressionsbehandlung. Aufgrund limitierter Möglichkeiten in der hausärztlichen Versorgung, gibt es in den USA schon seit einigen Jahren kollaborative Programme, die eine optimierte Vernetzung und Zusammenarbeit zwischen unterschiedlichen Behandlern vorsieht und speziell geschulte Case Manager einsetzt, um die übliche hausärztliche Behandlung mit kurzen verhaltenstherapeutischen Interventionen zu unterstützen. In Deutschland gibt es ebenfalls bereits neue Ansätze und Modelle um die Versorgung älterer depressiver Menschen zu verbessern, die aber noch weiterer Überprüfungen bedürfen.

Abstract

Depression is a common psychiatric disorder in older people. It is often accompanied by comorbid somatic conditions, and affected patients become frequent users of the health care system. Due to its relevance not only for the individual but also for society, reflection on the current health care service and optimization possibilities for the depressed elderly seems important and necessary. Mostly, the general practitioner is not only the first point of contact, but is also responsible for the entire treatment of depression. Due to the limited possibilities of primary care, for several years, there have been collaborative care programs in the USA that provide an optimized networking and collaboration between different health care providers and use specially trained care managers to support the usual primary health care service with short behavioral interventions. In Germany, there are also new approaches and models to improve the health care service for the depressed elderly, but these require further evaluation.

 
  • Literatur

  • 1 DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW. (Hrsg.). für die Leitliniengruppe Unipolare Depression * . S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression – Langfassung, 2. Auflage. 2015. Version 2. Im Internet: www.depression.versorgungsleitlinien.de Stand: 23.01.2016
  • 2 Alzheimer Europe – Research – European Collaboration on Dementia – Prevalence of dementia – Prevalence of dementia in Europe. Im Internet: http://www.alzheimer-europe.org/Research/European-Collaboration-on-Dementia/Prevalence-of-dementia/Prevalence-of-dementia-in-Europe Stand: 23.05.2015
  • 3 Luppa M, Sikorski C, Luck T. et al. Age- and gender-specific prevalence of depression in latest-life – Systematic review and meta-analysis. J Affect Disord 2012; 136: 212-221
  • 4 Meeks TW, Vahia IV, Lavretsky H. et al. A tune in ‘a minor’ can ‘b major’: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 2011; 129: 126-142
  • 5 Hölzel L, Härter M, Reese C. et al. Risk factors for chronic depression – A systematic review. J Affect Disord 2011; 129: 1-13
  • 6 Luppa M, Heinrich S, Matschinger H. et al. Direct costs associated with depression in old age in Germany. J Affect Disord 2008; 105: 195-204
  • 7 Mack S, Jacobi F, Gerschler A. et al. Self-reported utilization of mental health services in the adult German population – evidence for unmet needs? Results of the DEGS1-Mental Health Module (DEGS1-MH). Int J Methods Psychiatr Res 2014; 23: 289-303
  • 8 Melchior H, Schulz H, Härter M. Faktencheck Gesundheit Depression. Faktencheck Gesundh.Depress. Im Internet: https://depression.faktencheck-gesundheit.de/fachinformation/fachinformation-startseite/Stand: 11.05.2015
  • 9 Angermeyer MC, Matschinger H, Carta MG et al. Changes in the perception of mental illness stigma in Germany over the last two decades. Eur Psychiatry J Assoc Eur Psychiatr Published Online First: 6 December 2013
  • 10 Rabe-Menssen C. Barrieren der Inanspruchnahme von ambulanter Psychotherapie bei älteren Menschen. Psychother Aktuell 2011; 2011: 12-16
  • 11 Glaesmer H, Gunzelmann T, Martin A. et al. Die Bedeutung psychischer Beschwerden für die medizinische Inanspruchnahme und das Krankheitsverhalten Älterer. Psychiatr Prax 2008; 35: 187-193
  • 12 Sielk M, Altiner A, Janssen B. et al. Prevalence and diagnosis of depression in primary care. A critical comparison between PHQ-9 and GPs’ judgement. Psychiatr Prax 2009; 36: 169-174
  • 13 Jacobi F, Höfler M, Meister W. et al. Prevalence, detection and prescribing behavior in depressive syndromes. A German federal family physician study. Nervenarzt 2002; 73: 651-658
  • 14 Becker N, Abholz H-H. Prävalenz und Erkennen von depressiven Störungen in deutschen Allgemeinarztpraxen – eine systematische Literaturübersicht. ZFA – Z Für Allg 2005; 81: 474-481
  • 15 Dwight-Johnson M, Sherbourne CD, Liao D. et al. Treatment Preferences Among Depressed Primary Care Patients. J Gen Intern Med 2000; 15: 527-534
  • 16 Gühne U, Luppa M, König H-H et al. Are Psychotherapeutic Interventions Effective in Late-Life Depression? Psychiatr Prax Published Online First: 7 July 2014
  • 17 Beekman ATF, Geerlings SW, Deeg DJH. et al. The natural history of late-life depression: a 6-year prospective study in the community. Arch Gen Psychiatry 2002; 59: 605-611
  • 18 Reynolds K, Pietrzak RH, El-Gabalawy R. et al. Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry Off J World Psychiatr Assoc WPA 2015; 14: 74-81
  • 19 Lyness JM, Caine ED, King DA. et al. Psychiatric disorders in older primary care patients. J Gen Intern Med 1999; 14: 249-254
  • 20 Crystal S, Sambamoorthi U, Walkup JT. et al. Diagnosis and treatment of depression in the elderly medicare population: predictors, disparities, and trends. J Am Geriatr Soc 2003; 51: 1718-1728
  • 21 Gum AM, Areán PA, Hunkeler E. et al. Depression treatment preferences in older primary care patients. The Gerontologist 2006; 46: 14-22
  • 22 Callahan CM, Hendrie HC, Dittus RS. et al. Improving treatment of late life depression in primary care: a randomized clinical trial. J Am Geriatr Soc 1994; 42: 839-846
  • 23 Callahan CM. Quality improvement research on late life depression in primary care. Med Care 2001; 39: 772-784
  • 24 Thota AB, Sipe TA, Byard GJ. et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med 2012; 42: 525-538
  • 25 Gilbody S, Bower P, Fletcher J. et al. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med 2006; 166: 2314-2321
  • 26 Chang-Quan H, Bi-Rong D, Zhen-Chan L. et al. Collaborative care interventions for depression in the elderly: a systematic review of randomized controlled trials. J Investig Med Off Publ Am Fed Clin Res 2009; 57: 446-455
  • 27 Fortney J, Enderle M, McDougall S. et al. Implementation outcomes of evidence-based quality improvement for depression in VA community based outpatient clinics. Implement Sci 2012; 7: 30
  • 28 Unützer J, Katon W, Callahan CM. et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA J Am Med Assoc 2002; 288: 2836-2845
  • 29 Ciechanowski P, Wagner E, Schmaling K. et al. Community-integrated home-based depression treatment in older adults: A randomized controlled trial. JAMA 2004; 291: 1569-1577
  • 30 Dietrich AJ, Oxman TE, Williams JW. et al. Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial. BMJ 2004; 329: 602
  • 31 Cole MG, McCusker J, Elie M. et al. Systematic detection and multidisciplinary care of depression in older medical inpatients: a randomized trial. CMAJ Can Med Assoc J J Assoc Medicale Can 2006; 174: 38-44
  • 32 Hunkeler EM, Katon W, Tang L. et al. Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ 2006; 332: 259-263
  • 33 Chew-Graham CA, Lovell K, Roberts C. et al. A randomised controlled trial to test the feasibility of a collaborative care model for the management of depression in older people. Br J Gen Pract 2007; 57: 364-370
  • 34 Ross JT, TenHave T, Eakin AC. et al. A Randomized Controlled Trial of a Close Monitoring Program for Minor Depression and Distress. J Gen Intern Med 2008; 23: 1379-1385
  • 35 Gensichen J, von Korff M, Peitz M. et al. Case management for depression by health care assistants in small primary care practices: a cluster randomized trial. Ann Intern Med 2009; 151: 369-378
  • 36 Patel V, Weiss HA, Chowdhary N. et al. Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months. Br J Psychiatry J Ment Sci 2011; 199: 459-466
  • 37 Aragonès E, Lluís Piñol J, Caballero A. et al. Effectiveness of a multi-component programme for managing depression in primary care: A cluster randomized trial. The INDI project. J Affect Disord 2012; 142: 297-305
  • 38 Huijbregts KML, de Jong FJ, van Marwijk HWJ. et al. A target-driven collaborative care model for Major Depressive Disorder is effective in primary care in the Netherlands. A randomized clinical trial from the depression initiative. J Affect Disord 2013; 146: 328-337
  • 39 Richards DA, Hill JJ, Gask L. et al. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. BMJ 2013; 347: f4913
  • 40 Aragonès E, Caballero A, Piñol J-L. et al. Persistence in the long term of the effects of a collaborative care programme for depression in primary care. J Affect Disord 2014; 166: 36-40
  • 41 Klesse C, Bermejo I, Härter M. Neue Versorgungsmodelle in der Depressionsbehandlung. Nervenarzt 2007; 78: 585-596
  • 42 Wernher I, Bjerregaard F, Tinsel I. et al. Collaborative treatment of late-life depression in primary care (GermanIMPACT): study protocol of a cluster-randomized controlled trial. Trials 2014; 15: 351
  • 43 Arean P, Hegel M, Vannoy S. et al. Effectiveness of problem-solving therapy for older, primary care patients with depression: results from the IMPACT project. The Gerontologist 2008; 48: 311-323
  • 44 Fortney JC, Pyne JM, Mouden SB. et al. Practice-Based Versus Telemedicine-Based Collaborative Care for Depression in Rural Federally Qualified Health Centers: A Pragmatic Randomized Comparative Effectiveness Trial. Am J Psychiatry 2013; 170: 414
  • 45 Unutzer J, Katon WJ, Fan M-Y. et al. Long-term cost effects of collaborative care for late-life depression. Am J Manag Care 2008; 14: 95-100
  • 46 Riedel-Heller S, Luppa M. Depression im Alter – bevölkerungsmedizinisch unterschätzt?. PPmP – Psychother • Psychosom • Med Psychol 2014; 64: 477-479