[Clinical effectiveness of home treatment as compared to inpatient treatment at the Alexianer Hospital Krefeld, Germany]. / Psychiatrische Akutbehandlung ohne Krankenhausbett-Klinische Wirksamkeit von "Home Treatment" am Beispiel der "Integrativen Psychiatrischen Behandlung (IPB)" am Alexianer-Krankenhaus Krefeld.

ABSTRACT

BACKGROUND: Although all relevant guidelines recommend "home treatment" (HT) as part of psychiatric care, this strategy is very rarely applied in the German mental health system. For the first time HT was introduced in Germany as "integrative psychiatric treatment" (IPT) at the Alexianer Hospital in Krefeld. In the present study IPT was compared for the first time with inpatient treatment considering patient characteristics, drop-out rates, effects on symptoms and rehopitalisation after treatment. METHOD: 106 patients who had been treated by IPT in 2001 (or subgroups) were compared to patients who were treated as inpatients in the same year (or subgroups). RESULTS: Regarding sample characteristics IPT patients were significantly older and more often female than inpatients. Inpatients were more frequently diagnosed with organic, schizophrenia or personality disorders. The drop-out rate from IPT (inpatient stay during IPT treatment) was 17.9 % (n = 19). The pre-post effect sizes on symptoms in 14 randomly selected patients with schizophrenia were very large (d = 1.7 - 2.6). At two-year follow-up there were no differences between IPT and a matched inpatient sample with respect to days spent in inpatient treatment (25.4 vs.27.9 days). CONCLUSION: In the German mental health system, at least in a subgroup of severely mentally ill patients, treatment effects of HT are comparable to the effects of inpatient treatment.