Klassifikation von Verlaufstypen bei Patienten mit schizophrenen Erkrankungen. Ergebnisse der Längsschnittstudie ELAN

Hintergrund: Die Einteilung von Krankheits- bzw. Therapieverläufen von Patienten mit einer Störung aus dem schizophrenen Formenkreis in unterschiedliche Verlaufstypen ist von großem theoretischen und praktischen Wert, da durch eine Zuordnung behandlungsrelevante Konsequenzen eingeleitet und in Richtung "erfolgreiche Therapie" wirken können. Zunehmend Beachtung finden hierbei so genannte "multiple Verlaufs- und Outcomeparameter", d.h. Parameterkonstrukte, die mehrere Zielgrößen zugleich umfassen. Fragestellung: Es wird der Frage nachgegangen, ob Ansätze aus der latenten Wachstumskurvenanalyse genutzt werden können, um bei Patienten mit schizophrenen Erkrankungen eine Unterteilung in Krankheitsverlaufstypen vorzunehmen und ob die Einbeziehung von Kovariaten (Alter, Geschlecht, Indikatoren der Krankheit und Lebenssituation) eine Prädiktion zu den identifizierten Klassen ermöglicht. Methode: Die Verlaufsdaten von N = 374 schizophrenen Patienten (ICD-10: F20.-/F25.-) über 2 Jahre hinweg wurden mit dem Wachstumskurven-Ansatz nach Nagin (Latent Class Growth Analysis, LCGA) in unterschiedliche "Trajektorientypen" klassifiziert. Im Fokus stand hierbei das multiple Outcome-Kriterium mit den Indikatoren "Psychopathologie", "Funktionsniveau", "Lebensqualität" und "Kognition". Es wurden nicht-konditionale und konditionale Mischverteilungsmodelle berechnet. Ergebnisse: Durch die Datenanalyse wurden spezifische Klassen mit unterschiedlichen Kurvenverläufen identifiziert. Basierend auf statistischen Kennwerten wie auch inhaltlichen Aspekten fiel die Entscheidung für das dem "wahren Modell am nächsten kommend" zugunsten des konditionalen Modells mit 3-Klassen-Lösung und dem Prädiktor "Kognition" aus. Weiterhin konnte gezeigt werden, dass die Hinzunahme der Kovariaten Alter, Geschlecht und Kognition signifikanten Einfluss auf die Klassenzugehörigkeit haben. Schlussfolgerung: LCGA können einen Beitrag zur Identifikation günstiger wie auch ungünstiger Therapieverläufe leisten

Examining the cost effectiveness of interventions to promote the physical health of people with mental health problems: a systematic review

Recently attention has begun to focus not only on assessing the effectiveness of interventions to tackle mental health problems, but also on measures to prevent physical co-morbidity. Individuals with mental health problems are at significantly increased risk of chronic physical health problems, such as cardiovascular disease or diabetes, as well as reduced life expectancy. The excess costs of co-morbid physical and mental health problems are substantial. Potentially, measures to reduce the risk of co-morbid physical health problems may represent excellent value for money

European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods

Background: People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design: HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion: A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially