[Guideline-oriented inpatient psychiatric psychotherapeutic/psychosomatic treatment of anxiety disorders : How many personnel are need?]

Nervenarzt. 2016 Mar;87(3):302-10. doi: 10.1007/s00115-016-0085-1.
[Article in German]

Abstract

Background/objectives: The reimbursement of inpatient psychiatric psychotherapeutic/psychosomatic hospital treatment in Germany is regulated by the German personnel ordinance for psychiatric hospitals (Psych-PV), which has remained unchanged since 1991. The aim of this article was to estimate the personnel requirements for guideline-adherent psychiatric psychotherapeutic hospital treatment.

Methods: A normative concept for the required psychotherapeutic "dose" for anxiety disorders was determined based on a literature review. The required staffing contingent was compared to the resources provided by the Psych-PV based on category A1.

Results: According to the German policy guidelines for outpatient psychotherapy, a quota of 25 sessions of 50 min each (as a rule plus 5 probatory sessions) is reimbursed. This approach is supported by studies on dose-response relationships. As patients undergoing inpatient treatment for anxiety disorders are usually more severely ill than outpatients, a contingent of 30 sessions for the average treatment duration of 5 weeks seems appropriate in order to fully exploit the costly inpatient treatment time (300 min per patient and week). In contrast, only 70 min are reimbursed according to the Psych-PV. The total personnel requirement for the normative concept is 624 min per patient and week. The Psych-PV only covers 488 min (78 %).

Conclusion: Currently, the time contingents for evidence-based psychiatric psychotherapeutic/psychosomatic hospital care are nowhere near sufficient. In the development of future reimbursement systems this needs to be corrected.

Keywords: Anxiety disorders; Guidelines; Inpatients; Psychiatry Personnel Act; Psychotherapy.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Anxiety Disorders / economics
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / therapy*
  • Chronic Disease
  • Clinical Competence / economics
  • Clinical Competence / standards
  • Germany / epidemiology
  • Guideline Adherence / economics
  • Guideline Adherence / standards
  • Guideline Adherence / statistics & numerical data
  • Hospitals, Psychiatric / economics
  • Hospitals, Psychiatric / standards*
  • Hospitals, Psychiatric / statistics & numerical data*
  • Humans
  • Middle Aged
  • Needs Assessment / economics
  • Personnel Staffing and Scheduling / economics
  • Personnel Staffing and Scheduling / statistics & numerical data*
  • Practice Guidelines as Topic
  • Prevalence
  • Psychiatry* / economics
  • Psychiatry* / standards
  • Psychiatry* / statistics & numerical data
  • Psychotherapy / economics
  • Psychotherapy / standards*
  • Psychotherapy / statistics & numerical data
  • Utilization Review
  • Workforce
  • Young Adult