Assessmentgesteuertes Home Treatment für Patienten mit schweren psychotischen Störungen

Zusammenfassung

Anliegen: Es gibt Evidenz für die Wirksamkeit aufsuchender außerklinischer Behandlung von akuten schweren psychischen Störungen. In Deutschland gibt es bisher nur wenig klar definierte Modelle.

Methode: Vorstellung eines modularisierten Modells im Rahmen einer prospektiven Untersuchung. Die Definition und Verteilung spezifischer therapeutischer Aufgaben an einzelne Berufsgruppen soll eine hohe Manualtreue ermöglichen.

Ergebnis und Diskussion: In 15 Monaten erfolgten rund 600 Hausbesuche bei 32 Patienten. Der Median lag bei 15,5 Hausbesuchen/Patient. Es zeigte sich eine signifikant erhöhte Akzeptanz gegenüber dieser ambulanten Behandlungsform (Abbruchrate 16 %) im Vergleich zu vorangegangen stationären Behandlungen (Abbruchrate 50 %) (Chi-Quadrat-Test, p = 0,003). Die Arbeit zeigt die Umsetzbarkeit und Akzeptanz dieses Modells einer aufsuchenden Therapie.

Abstract

Objective: Although there is growing evidence for clinical effectiveness of crisis resolution teams (also called Home Treatment Teams) for patients with severe psychotic disorders, a lot of studies suffer from poor model fidelity, which leads to an ignorance of specific effective factors.

Methods: Here we present the implementation of an assessment-based Home Treatment in Germany. Assessment-derived therapeutic tasks are shared between team members by a manualized process.

Results: We visited 32 patients almost 600 times in 15 months. The median was 15.5 visits per patient. Adherence to Home Treatment intervention was significantly stronger (unplanned discharge 16 %) compared to prior hospitalization (unplanned discharge 50 %) (Chi-square test, p = 0.003).

Conclusion: Applying this model, a detailed definition of specific tasks for team members leads to a high model fidelity and increases patientsʼ compliance to therapy.

Schlüsselwörter

schwere psychotische Störung - Manualtreue - aufsuchende Behandlung - Home Treatment

Keywords

crisis resolution - home treatment - severe psychotic disorder - model fidelity - assessment

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