Disease-Management und Versorgungsintegration bei Depressionen:
Gibt es Evidenz für eine Beeinflussung des Krankheitsverlaufes, der
Lebensqualität und der Inanspruchnahme des Gesundheitswesens?
Affiliations: Lehrstuhl für Gesundheitswissenschaften der
Medizinischen Fakultät "Carl Gustav Carus" der Technischen
Universität Dresden | IGES Institut für Gesundheits- und
Sozialforschung GmbH, Berlin
Note: [] Korrespondenzadresse: Dr. med. Dipl.-Komm. wirt Holger Gothe,
Lehrstuhl für Gesundheitswissenschaften der Medizinischen Fakultät
"Carl Gustav Carus" der Technischen Universität Dresden, Institut für
Medizinische Biometrie und Informatik, Löscherstraße 18, 01307
Dresden. Tel.: 0351 3177 217; Fax: 0351 3177 33217; E-mail:
H.Gothe@t-online.de.
Abstract: Disease management and integrated health care for depression: Is
there evidence for effects on the course of disease, quality of life, and
utilization patterns? Depression is one of the most common diseases world-wide associated
with high societal costs and reduced quality of life. New approaches in health
care delivery such as integrated care or disease management programs (DMP) aim
at compensating major care deficits, but evidence regarding the actually
achieved benefits for Germany is still lacking. This paper gives an overview on
two recently performed studies focussing both approaches. The first study provides an evaluation of DMP for the treatment of
depression. A meta-analysis has been performed including 10 RCT. Findings
suggest that quality of care in terms of 'depression severity', 'patient
satisfaction', and 'implementation of guideline driven care' can be enhanced by
comprehensive DMP. Health related quality of life was analysed in only 4 of 10
RCT showing heterogeneous results. The other study compares primary care patients with psychological
problems in a gate keeper system (the Netherlands) and in an open access system
(Germany). The gate keeper system restrains utilization of care in terms of
physician contacts and intensity of treatment, while at the same time part of
specialist treatment is transfered to inpatient services. The question remains
unanswered whether, in contrast to the expected advantages of integrated health
care concepts, this does not indicate inadequate ambulatory care.
Keywords: Depression, disease management, integrated health care, utilization of medical services, gatekeeping
