title: [Integrated care for patients with first and multiple episodes of severe psychotic illnesses: 3-year results of the Hamburg model].
abstract: BACKGROUND
  The so-called "Hamburg model" is a designated integrated care model according to § 140 of the Social Code Book (SGB) V for psychosis patients fulfilling the definition of severe mental illness (SMI).
  
  
  OBJECTIVE
  Description of the model and evaluation of efficacy of all patients being treated for ≥ 3 years.
  
  
  METHODS
  Service entry illness status, course of illness, and interventions were assessed within a continuous quality assurance study. One hundred and fifty-eight patients who fulfilled the criterion of being treated for ≥ 3 years were analyzed.
  
  
  RESULTS
  At service entry, SMI were among others mirrored by a high level of psychopathology (Brief Psychiatric Rating Scale [BPRS]: 80.3) and severity of illness (Clinical Global Impression Severity [CGI-S]/Clinical Global Impression Bipolar scales [CGI-BP]: 5.8), low functioning level (Global Assessment of Functioning scale [GAF]: 35.9), and high rates of comorbid psychiatric (94.3 %) and somatic (81.6 %) disorders. Only 8 patients (5.1 %) disengaged from the service within the 3-year treatment period. The course of the illness over 3 years showed significant and stable improvements in psychopathology (BPRS: p < 0.001), the severity of illness (CGI-S/CGI-BP: p < 0.001), functioning (GAF: p < 0.001), quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire [Q-LES-Q-18]: p < 0.001), and satisfaction with care (Client Satisfaction Questionnaire [CSQ-8]: 2.0 to 3.3; p = 0.164; nonsignificant because of early improvements). Further, compulsory admissions were reduced and medication adherence in addition to working ability improved (all p < 0.001). Data on interventions showed a continuously high frequency of outpatient interventions over time (on average 112.0 per year), a high percentage of patients in psychotherapy (67 %), and a nearly 90 % reduction in inpatient treatment days from year 1 to year 3.
  
  
  CONCLUSIONS
  Integrated care in severely ill patients with psychotic disorders leads to multidimensional illness improvement and stabilization by offering intensive outpatient care.
authors: Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland, lambert@uke.de.
authors: Martin
authors: M
authors: Lambert
authors: D
authors: D
authors: Schöttle
authors: F
authors: F
authors: Ruppelt
authors: D
authors: D
authors: Lüdecke
authors: G
authors: G
authors: Sarikaya
authors: M
authors: M
authors: Schulte-Markwort
authors: J
authors: J
authors: Gallinat
authors: A
authors: A
authors: Karow
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D017146:Models, Organizational; D009937:Organizational Objectives; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation / Q000379:methods; D011618:Psychotic Disorders / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome