3 research outputs found
To what extent are psychiatrists aware of the comorbid somatic illnesses of their patients with serious mental illnesses? – a cross-sectional secondary data analysis
Background Somatic comorbidities are a serious problem in patients with severe
mental illnesses. These comorbidities often remain undiagnosed for a long
time. In Germany, physicians are not allowed to access patients’ health
insurance data and do not have routine access to documentation from other
providers of health care. Against this background, the objective of this
article was to investigate psychiatrists’ knowledge of relevant somatic
comorbidities in their patients with severe mental illnesses. Methods Cross-
sectional secondary data analysis was performed using primary data from a
prospective study evaluating a model of integrated care of patients with
serious mental illnesses. The primary data were linked with claims data from
health insurers. Patients’ diagnoses were derived on the basis of the ICD-10
and the Anatomical Therapeutic Chemical (ATC) classification system. Diabetes,
hypertension, coronary artery disease (CAD), hyperlipidaemia, glaucoma,
osteoporosis, polyarthritis and chronic obstructive pulmonary disease (COPD)
were selected for evaluation. We compared the number of diagnoses reported in
the psychiatrists’ clinical report forms with those in the health insurance
data. Results The study evaluated records from 1,195 patients with severe
mental illnesses. The frequency of documentation of hypertension ranged from
21% in claims data to 4% in psychiatrists’ documentation, for COPD from 12 to
0%, respectively, and for diabetes from 7 to 2%, respectively. The percentage
of diagnoses deduced from claims data but not documented by psychiatrists
ranged from 68% for diabetes and 83% for hypertension, to 90% for CAD to 98%
for COPD. Conclusions The majority of psychiatrists participating in the
integrated care programme were insufficiently aware of the somatic
comorbidities of their patients. We support allowing physicians to access
patients’ entire medical records to increase their knowledge of patients’
medical histories and, consequently, to increase the safety and quality of
care
Promoting stigma coping and empowerment in patients with schizophrenia and depression: results of a cluster-RCT
There is a need for interventions supporting patients with mental health conditions in coping with stigma and discrimination. A psycho-educational group therapy module to promote stigma coping and empowerment (STEM) was developed and tested for efficacy in patients with schizophrenia or depression. 30 clinical centers participated in a cluster-randomized clinical trial, representing a broad spectrum of mental health care settings: in-patient (acute treatment, rehabilitation), out-patient, and day-hospitals. As randomized, patients in the intervention group clusters/centers received an illness-specific eight sessions standard psychoeducational group therapy plus three specific sessions on stigma coping and empowerment ('STEM'). In the control group clusters the same standard psychoeducational group therapy was extended to 11 sessions followed by one booster session in both conditions. In total,N = 462 patients were included in the analysis (N = 117 with schizophrenia spectrum disorders, ICD-10 F2x;N = 345 with depression, ICD-10 F31.3-F31.5, F32-F34, and F43.2). Clinical and stigma-related measures were assessed before and directly after treatment, as well as after 6 weeks, 6 months, and 12 months (M12). Primary outcome was improvement in quality of life (QoL) assessed with the WHO-QOL-BREF between pre-assessment and M12 analyzed by mixed models and adjusted for pre-treatment differences. Overall, QoL and secondary outcome measures (symptoms, functioning, compliance, internalized stigma, self-esteem, empowerment) improved significantly, but there was no significant difference between intervention and control group. The short STEM module has proven its practicability as an add-on in different settings in routine mental health care. The overall increase in empowerment in both, schizophrenia and depression, indicates patients' treatment benefit. However, factors contributing to improvement need to be explored. The study has been registered in the following trial registers. ClinicalTrials.gov:Registration number: NCT01655368. DRKS:Registration number: DRKS00004217