title: [Decentralized outpatient teams in community-based psychiatric care: comparison of two Bavarian rural catchment areas].
abstract: BACKGROUND
  Psychiatric outpatient clinics (PIAs) are an indispensable care service for crisis intervention and multidisciplinary treatment of people suffering from severe and persistent mental disorders. The decentralization of outpatient clinics can be understood as a further step in the deinstitutionalization process.
  
  
  METHODS
  This cross-sectional study (n=1,663) compared the central outpatient clinic with the decentralized teams for the year 2010 by means of analyses of variance, χ(2)-tests and robust multivariate regression models. The longitudinal assessment (descriptively and by means of Prais-Winsten regression models for time series) was based on all hospitalizations for the two decentralized teams (n = 6,693) according to partial catchment areas for the time period 2002-2010 in order to examine trends after their installation in the year 2007.
  
  
  RESULTS
  Decentralized teams were found to be similar with respect to the care profile but cared for relatively more patients suffering from dementia, addictive and mood disorders but not for those suffering from schizophrenia and personality disorders. Decentralized teams showed less outpatient care costs as well as psychopharmacological expenses but a lower contact frequency than the central outpatient clinic. Total expenses for psychiatric care were not significantly different and assessed hospitalization variables (e.g. total number of annual admissions, cumulative length of inpatient-stay and annual hospitalizations per patient) changed slightly 3 years after installation of the decentralized teams. The number of admissions of people suffering from schizophrenia decreased whereas those for mood and stress disorders increased.
  
  
  CONCLUSIONS
  Decentralized outpatient teams seemed to reach patients in rural regions who previously were not reached by the central outpatient clinic. Economic figures indicate advantages for the installation of such teams because care expenses are not higher than for patients treated in centralized outpatient clinics and because hospitalization figures for the whole catchment area did not increase.
authors.affiliation: Abteilung Psychosomatische Medizin, Zentrum für Psychiatrie Südwürttemberg, Universität Ulm - Klinik für Psychiatrie und Psychotherapie I, Weingartshoferstr. 2, 88212, Ravensburg, Deutschland, juan.valdes-stauber@zfp-zentrum.de.
authors.forename: J
authors.initials: J
authors.lastname: Valdes-Stauber
authors.forename: A
authors.initials: A
authors.lastname: Putzhammer
authors.forename: R
authors.initials: R
authors.lastname: Kilian
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000554:Ambulatory Care Facilities / Q000191:economics* / Q000706:statistics & numerical data; D002391:Catchment Area, Health / Q000191:economics* / Q000706:statistics & numerical data; D003156:Community Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D019058:Community Networks / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000191:economics* / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000191:economics* / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D014600:Utilization Review