SOME ASPECTS OF THE ACTUAL SITUATION OF PSYCHOSOMATIC - - PDF document

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SOME ASPECTS OF THE ACTUAL SITUATION OF PSYCHOSOMATIC - - PDF document

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U N I V E R S I T T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N BERLIN 09.07.2005 SOME ASPECTS OF THE ACTUAL SITUATION OF PSYCHOSOMATIC MEDICINE IN GERMANY ULRICH T. EGLE U N I V E R S I T T

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U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

BERLIN 09.07.2005

SOME ASPECTS OF THE ACTUAL SITUATION OF PSYCHOSOMATIC MEDICINE IN GERMANY

ULRICH T. EGLE

U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

psychosomatic sheikhdom diagnostic reefs l

  • n

g f l

  • w

/ r i v e r

  • f

s p e e c h

laboratory center corner Lake district grove marshland borderlands

Sea of

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U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

PSYCHOSOMATIC MEDICINE IN GERMANY FOUR STEPS OF HEALTH CARE

  • Psychosomatic basic competence

Psychosomatic basic competence

  • 60 000 physicians (68% of all gynecologists and 62% of all GPs)

60 000 physicians (68% of all gynecologists and 62% of all GPs)

  • Outpatient psychotherapy

Outpatient psychotherapy

  • 15 500 psychotherapists

15 500 psychotherapists (3500 are physicians with specialization in (3500 are physicians with specialization in „ „Psychosomatic Medicine Psychosomatic Medicine and Psychotherapy and Psychotherapy“ “, 12 000 psychologists) , 12 000 psychologists)

  • Inpatient psychotherapy/psychosomatic medicine

Inpatient psychotherapy/psychosomatic medicine

  • 3200 beds in 25 university departments and 39 other hospitals

3200 beds in 25 university departments and 39 other hospitals >> 25 000 patients in 2002 (45 days/patient, range: 3 to 12 week >> 25 000 patients in 2002 (45 days/patient, range: 3 to 12 weeks) s)

  • Psychosomatic rehabilitation

Psychosomatic rehabilitation

  • 15 500 beds in rehabilitation clinics

15 500 beds in rehabilitation clinics >> 140 000 patients in 2002 (M=38 days/patient) >> 140 000 patients in 2002 (M=38 days/patient)

U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

BASIC COMPETENCE IN PSYCHOSOMATICS

Medical curriculum

Obligatory lecture (24 h) and course (12 h) of psychosomatic

medicine for all medical students in the 5th year Continuing education

20 h lectures on theoretical know-how 30 h practice of doctor-patient-communication 30 h Balint group (understanding doctor-patient-relationship)

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U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

Mean number of psychotherapeutic sessions of outpatient treatment paid by German health insurances: 78 (2003)

U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

CURRICULUM FOR SPECIALIZATION IN „PSYCHOSOMATIC MEDICINE AND PSYCHOTHERAPY“ IN GERMANY

  • 1 year in psychiatry

1 year in psychiatry

  • 1 year internal medicine (6 month neurology or 6 month

1 year internal medicine (6 month neurology or 6 month gynecology possible) gynecology possible)

  • 3 years psychosomatic medicine

3 years psychosomatic medicine

2 years of inpatient treatment 1 year of outpatient treatment and CL-service 150 h of self-experiences 1500 h of psychotherapeutic sessions with supervision diagnostic examinations of 150 (?) patients Alternative between cognitive-behavioral or

psychodynamic focus of the curriculum

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U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

SPECTRUM OF DISORDERS TREATED IN PSYCHIATRIC HOSPITALS IN GERMANY

(Deutsche Angestellten Krankenkasse, 2003). N=22.264 female patients and N=15.474 male patients U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

DIAGNOSTIC SPECTRUM OF DISORDERS TREATED IN PSYCHIATRIC AND IN PSYCHOSOMATIC DEPARTMENTS

ICD-10-Erstdiagnosen einer Klinik f r Psychosomatische Medizin und eine r Klinik f r Psychiatrie und Psychotherapie an einem Krankenhaus der Maximalversorgung 2003

(im Vergleich die H ufigkeiten einer Universit tspsychiatrie [Berger 2004 ])

10 20 30 40 50 60 % F0 F1 F2 F3 F4 F5 F6 F7 Sonstige

Psychosomatik Psychiatrie Referenz-Psychiatrie (Berger 2004)

Hildenbrand 2005

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U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

Target: 5 bed for psychosomatic inpatient treatment for 100 000 inhabitants > 18 years

U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

SPECTRUM OF DIAGNOSES OF PSYCHOSOMATIC INPATIENT REHABILITATION (2002, N=140 000)

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U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

ECONOMIC RESULTS OF PSYCHOSOMATIC INPATIENT TREATMENT

(DAK/AHG study, Zielke 2004)

N=338 members of a large German health insurance company

(DAK) treated in 3 psychosomatic hospitals with CBT (from 16.1.99 to 22.2.2000)

N=252 with a sick certificate in the past 2 years

wrote off sick on average for 24,5 weeks (median) 48% because of psychic problems/disorders

27% because of chronic pain

length of the disorder 7,3 years (median)

U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

ECONOMIC RESULTS OF PSYCHOSOMATIC INPATIENT TREATMENT

(DAK/AHG study, Zielke 2004) Health costs for each case (€) 2 2-

  • yr before

yr before 2 2-

  • yr after

yr after

Health insurance

12 700 6 800

(e.g. costs of out- and inpatient treatments, drugs, sick pay)

Employer

27 100 11 400

(e.g. statutory sick pay, loss of productivity)

Total

39 800 18 200

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U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

ECONOMIC RESULTS OF PSYCHOSOMATIC INPATIENT TREATMENT

(DAK/AHG study, Zielke 2004) Costs of inpatient treatment Costs of inpatient treatment

Mean length of treatment

51,6 days

Daily rate for inpatient care

110 € each day >> average costs of treatment for each case: >> average costs of treatment for each case: € 5676.-

U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

ECONOMIC RESULTS OF PSYCHOSOMATIC INPATIENT TREATMENT

(DAK/AHG study, Zielke 2004)

cost-benefit-relation

  • reduction of costs for health

reduction of costs for health

  • 21 550

21 550 € €

  • average costs of treatment

average costs of treatment 5 680 5 680 € €

1 : 3,79

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U N I V E R S I T Ä T S K L I N I K U M M A I N Z P S Y C H O S O M A T I S C H E M E D I Z I N

E G L E

ECONOMIC RESULTS OF PSYCHOSOMATIC INPATIENT TREATMENT

(DAK/AHG study, Zielke 2004)

Analysis of opportunity

calculation calculation considering considering productivity productivity of commercial

  • f commercial employees

employees using using a a formula formula from from buissness buissness mangement mangement

>> >> Net Net benefit benefit for for each each case case € 48 224.- >> Net benefit of the N=252 patients in the study: > € 12 Mio.