[Who gets how much psychiatric outpatient care and why?].
OBJECTIVE
To elucidate the connections between individual aspects and patients' concerns and the care effort provided in a clinic for the sickest among outpatients.


METHODS
Clients of one health insurer were followed for six months (n = 339) in a "Institutsambulanz" or "PIA". All treatment activities, which involved roughly 100,000 working minutes, were recorded. Sociodemographic data, the diagnoses, the individual needs and idiosyncracies, symptoms and case history were noted for multivariate analysis.


RESULTS
The linear regression model with the best fit (n = 251, r (2) = 0.512, p < 0.001) included six variables. Lower efforts: living in nursing home (beta = - 0.319; p < 0.001), higher age (beta = - 0.238; p < 0.001), legal incapacity (beta = - 0.165, p = 0.006), own work income (beta = - 0.100; p = 0.044); higher efforts: inpatient stays prior to study treatment (lifetime: beta = 0.181; p = 0.001; number of days in last two years: beta = 0.193; p < 0.001). Treatment aims, functional deficits, and diagnoses did not have a significant influence.


CONCLUSIONS
Younger patients who wish for an independent life despite of a grave psychiatric disorder may effectuate higher treatment efforts. Treatments administered to nursing-home inhabitants are far less complex, although these patients are even sicker. The current reimbursement mechanism may serve as a disincentive towards care administration according to individual need.
Wedegärtner
Felix
F
Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Zentrum für seelische Gesundheit, Medizinische Hochschule Hannover, 30625 Hannover. wedegaertner.felix@mh-hannover.de
Wedegärtner
Carolin
C
Müller-Thomsen
Tomas
T
Bleich
Stefan
S
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D057187:Independent Living / Q000523:psychology; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014600:Utilization Review / Q000706:statistics & numerical data; D055815:Young Adult