Flexible and Integrative Psychiatric Care Based on a Global Treatment Budget: Comparing the Implementation in Germany and Poland

Julian Schwarz; Andrzej Cechnicki; Jan Godyń; Laura Galbusera; Daria Biechowska; Beata Galińska-Skok; Izabela Ciunczyk; Yuriy Ignatyev; Felix Muehlensiepen; Bettina Soltmann; Jürgen Timm; Sebastian von Peter; Marek Balicki; Jacek Wciórka; Martin Heinze

doi:10.3389/fpsyt.2021.760276

Flexible and Integrative Psychiatric Care Based on a Global Treatment Budget: Comparing the Implementation in Germany and Poland

Front Psychiatry. 2022 Jan 7:12:760276. doi: 10.3389/fpsyt.2021.760276. eCollection 2021.

Authors

Julian Schwarz¹, Andrzej Cechnicki², Jan Godyń³, Laura Galbusera¹, Daria Biechowska⁴, Beata Galińska-Skok⁵, Izabela Ciunczyk⁶, Yuriy Ignatyev⁷, Felix Muehlensiepen^{7

8}, Bettina Soltmann⁹, Jürgen Timm¹⁰, Sebastian von Peter¹, Marek Balicki¹¹, Jacek Wciórka¹¹, Martin Heinze^{1

7}

Affiliations

¹ Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Clinic Rüdersdorf, Rüdersdorf, Germany.
² Community Psychiatry and Psychosis Research Centre, Jagiellonian University Medical College, Krakow, Poland.
³ Psychosis Research Unit, Association for the Development of Community Psychiatry and Care, Krakow, Poland.
⁴ Department of Public Health, Institute of Psychiatry and Neurology, Warsaw, Poland.
⁵ Department of Psychiatry, Medical University of Bialystok, Białystok, Poland.
⁶ Middle Pomeranian Mental Health Centre "Medison", Koszalin, Poland.
⁷ Centre for Health Services Research Brandenburg, Brandenburg Medical School, Rüdersdorf, Germany.
⁸ Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany.
⁹ Department of Psychiatry and Psychotherapy, Medical Faculty, Carl Gustav Carus University Hospital, Technical University Dresden, Dresden, Germany.
¹⁰ Biometry Section, Competence Centre for Clinical Trials, University of Bremen, Bremen, Germany.
¹¹ Pilot Program Office of the National Mental Health Program, Institute of Psychiatry and Neurology, Warsaw, Poland.

Abstract

Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany. Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared. Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition. Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems.

Keywords: complex intervention; global budget payment; health service research; home treatment; integrated mental health care; mental health systems research; process evaluation.