[Integrated care for depressive disorders]

According to the special report of the Advisory Council on the Assessment of Developments in the Health Care Sector, the termination of contracts on integrated care (IC) in accordance with §140a-d of the Social Act V (SGB V) was mostly due to high costs and volume expansion by services providers (physicians). However, there is still limited knowledge about the medical and economic impact of projects of integrated care, as such projects were on the one hand not primarily designed with a scientific evaluation in mind and on the other hand health insurance agencies usually do not evaluate data for scientific reasons.

In Aachen the IC project "Integrated Care in Mental Health" ran between 2006 and 2011. During that time a total of 3,408 patients with depressive disorders were treated across institutional and trans-sectoral borders according to the national clinical practice guidelines and S3 guidelines on unipolar depression. This study was initiated in an attempt to describe and evaluate the clinical success of treatment.

This study evaluated the outcome of the clinical treatment provided but due to the lack of available data on the economic impact of the project, the study contribution is limited to non-economic aspects. By comparing various clinical parameters it could be shown that scores in certain patient-reported clinical scales, such as the Hamilton rating scale for depression, and the WHO-5 well-being index as well as on the clinician-reported clinical global impression (CGI) improved in a statistically significant manner over time compared to initial assessments. Due to the lack of data on an appropriate comparison cohort of patients any comparative statements concerning the superiority of the treatment of depressive disorders outside an integrated care project remains hypothetical and preliminary.

This study revealed the limitations of a naturalistic study in an IC setting and showed that without adequate funding a satisfactory evaluation that fulfills scientific criteria seems to be impossible.