[Effect of a geriatric psychiatric center on quality of care for elderly psychiatric patients].
The goal of this evaluation study is to analyze the effects of a new gerontopsychiatric institution, the gerontopsychiatric center (GC: a combination of a home-based outpatient service, a day-hospital and a consulting office for elderly with mental disorders) on the reorganization process of the treatment system from intramural toward extramural structures, as experts of the government of the FRG have been demanding for a long time. Based on data of cross-sectional and longitudinal studies two regional catchment areas--the city of Bielefeld (without GC, control region) and the district of Gütersloh (with GC)--are compared and analyzed, whether changes within the gerontopsychiatric system (subsystem A), the system of general medical treatment (subsystem B), or within the elderly care system (subsystem C) occurred. Concerning subsystem A the results are that the GC has a strong impact on the intended shift from intra- to extramural structures, without selecting patients by diagnosis nor by severity degrees of their mental disorders in extramural treatment facilities. The home-based outpatient treatment is especially successful for elderly with a functional psychic disorder. These patients had the highest scores in improvement of psychiatric symptoms as well as in reduction of their self-care deficits within one year. Effects of the GC on subsystem B were evident soon after its establishment, for example, by the increasing cooperation between the gerontopsychiatric health services and general hospitals in the region with GC, in which (hospitals) two fifths of all clinical gerontopsychiatric patients with a mental disorder as the main diagnosis (ICD-9) are treated. An effect of the GC on subsystem C is possibly the fact that in its region the rate of direct transfers of patients from the clinical gerontopsychiatric department into homes for the elderly is significantly lower than in the region without GC.
Steinkamp
G
G
Fakultät für Soziologie, Universität Bielefeld. guenther.steinkamp@post.uni-bielefeld.de
Werner
B
B
D000368:Aged; D000553:Ambulatory Care; D003631:Day Care, Medical; D003704:Dementia / Q000175:diagnosis / Q000534:rehabilitation*; D015577:Geriatric Assessment; D005858:Germany; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes; D010348:Patient Care Team; D011785:Quality Assurance, Health Care; D011788:Quality of Life; D012047:Rehabilitation Centers