[Who gets how much psychiatric outpatient care and why?]

To elucidate the connections between individual aspects and patients' concerns and the care effort provided in a clinic for the sickest among outpatients.

Clients of one health insurer were followed for six months (n = 339) in a "Institutsambulanz" or "PIA". All treatment activities, which involved roughly 100,000 working minutes, were recorded. Sociodemographic data, the diagnoses, the individual needs and idiosyncracies, symptoms and case history were noted for multivariate analysis.

The linear regression model with the best fit (n = 251, r (2) = 0.512, p < 0.001) included six variables. Lower efforts: living in nursing home (beta = - 0.319; p < 0.001), higher age (beta = - 0.238; p < 0.001), legal incapacity (beta = - 0.165, p = 0.006), own work income (beta = - 0.100; p = 0.044); higher efforts: inpatient stays prior to study treatment (lifetime: beta = 0.181; p = 0.001; number of days in last two years: beta = 0.193; p < 0.001). Treatment aims, functional deficits, and diagnoses did not have a significant influence.

Younger patients who wish for an independent life despite of a grave psychiatric disorder may effectuate higher treatment efforts. Treatments administered to nursing-home inhabitants are far less complex, although these patients are even sicker. The current reimbursement mechanism may serve as a disincentive towards care administration according to individual need.