[The Structural Reform in Outpatient Psychotherapy Shows Effects in Health Service Utilization, Especially in Younger Patients]. / Nach der Strukturreform der ambulanten Psychotherapie zeigen sich vor allem in jüngeren Altersgruppen Effekte.

AIM OF THE STUDY: The aim of the structural reform of outpatient psychotherapy in Germany in 2017 was to make access to psychotherapy guideline easier and more flexible. The aim of the present study was to investigate whether more people gained access to outpatient psychotherapy after the reform and the treatment pathways they used in the process. METHODOLOGY: From the nationwide AOK routine data, 2 cohorts (2016 and 2019) of insured persons with a newly made diagnosis indicating the need for psychotherapy were identified and subdivided according to age and gender. The extent to which these insurees received treatment within the framework of psychotherapy guideline and the treatment elements used in the process were examined. RESULTS: After the reform, a greater percentage of insurees with a mental disorder received treatment under the psychotherapy guideline. More women accessed treatment, with pronounced increase among adolescents and young adults. The newly introduced services of psychotherapeutic consultation hours and acute treatment were widely used. CONCLUSIONS: The results indicate that the reform has succeeded in facilitating access to outpatient psychotherapy, at least in some population groups. In addition, the new psychotherapeutic consultation hours now seem to cover a psychotherapeutic counselling need that was previously not explicitly included in the fee schedule.

Treated post-acute sequelae after COVID-19 in a German matched cohort study using routine data from 230,256 adults.

Background: Post-acute sequelae after COVID-19 are still associated with knowledge gaps and uncertainties at the end of 2022, e.g., prevalence, pathogenesis, treatment, and long-term outcomes, and pose challenges for health providers in medical management. The aim of this study was to contribute to the understanding of the multi-faceted condition of long-/ post-COVID. It was designed to evaluate whether a prior SARS-CoV-2 infection during the first COVID-19 wave in Germany increases the rate of disease, as measured via a record of insurance data on diagnoses, symptoms, and treatment, in the subsequent 12 months compared with matched control groups without recorded SARS-CoV-2 infection. Method: 50 outcome variables at disease, symptom and treatment levels (14 main categories and 36 sub-categories; new diagnoses) were defined from health insurance data. Logistic regression was carried out for two groups of patients tested positive in a PCR test in March/April 2020 for SARS-CoV-2, compared to the respective risk-adjusted (age, administrative region, 1:5 propensity-score matching), contemporaneous control group without prior documented SARS-CoV-2 infection (CG): First, individuals with outpatient treatment of acute COVID-19, indicating a not severe course (COV-OUT), and second, individuals with inpatient treatment of acute COVID-19, indicating a severe course (COV-IN) were compared with their respective control group. Results: The mortality rate in COV-OUT (n = 32,378) and COV-IN (n = 5,998) groups is higher compared to their control groups with odds ratio (OR) 1.5 [95%CI (1.3, 1.6)] and 1.7 [95%CI (1.5, 1.8)] respectively. Both groups were more likely to have experienced at least one outcome compared to their CG [OR = 1.4, 95%CI (1.4, 1.4)]; OR = 2.5, 95%CI [2.4, 2.6]). 42/37 (COV-IN/COV-OUT) outcome variables showed increased ORs. COV-OUT: Loss of taste and smell [OR = 5.8, 95%CI (5.1, 6.6)], interstitial respiratory diseases [OR = 2.8, 95%CI (2.0, 4.1)] and breathing disorders [OR = 3.2, 95%CI (2.2, 4.7)] showed the highest ORs. COV-IN: Interstitial respiratory diseases [OR = 12.2, 95%CI (8.5, 17.5)], oxygen therapy [OR = 8.1, 95%CI (6.4, 10.2)] and pulmonary embolism/anticoagulation [OR = 5.9, 95%CI (4.4, 7.9)] were the most pronounced. Conclusion: Following a SARS-CoV-2 infection during the first wave of the COVID-19 pandemic in Germany, 8.4 [COV-OUT, 95%CI (7.7, 9.1)] respectively 25.5 [COV-IN, 95%CI (23.6, 27.4)] percentage points more subjects showed at least one new diagnosis/symptom/treatment compared to their matched CG (COV-OUT: 44.9%, CG: 36.5%; COV-IN: 72.0%, CG: 46.5%). Because the symptoms and diagnoses are so varied, interdisciplinary and interprofessional cooperation among those providing management is necessary.