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[Rationing in inpatient psychiatric care].

B Braun1, P Brückner-Bozetti2, M Lingenfelder3

  • 1Zentrum für Sozialpolitik (ZeS)/SOCIUM, Universität Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Deutschland. bbraun@zes.uni-bremen.de.

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Summary

Implicit rationing of essential psychiatric services, including patient communication and treatment coordination, affects 42-59% of healthcare professionals. High caseloads and workload predict this rationing, jeopardizing effective mental healthcare.

Keywords:
Implicit rationingNursing personnelPhysicians/psychologistsPsychiatric treatmentRemuneration system PEPP

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Area of Science:

  • Psychiatry
  • Healthcare Management
  • Health Services Research

Background:

  • Implicit rationing of healthcare services is a growing concern in psychiatric institutions.
  • Understanding the extent and nature of this rationing is crucial for improving patient care.

Purpose of the Study:

  • To investigate the prevalence and specific services affected by implicit rationing in German psychiatric hospitals.
  • To identify factors contributing to implicit rationing from the perspectives of physicians and nurses.

Main Methods:

  • A written, standardized survey was administered to 256 physicians/psychologists and 796 nurses across eight German psychiatric hospitals.
  • Data collection occurred from October 2013 to mid-2014.

Main Results:

  • 42-59% of surveyed professionals reported insufficient execution or implicit rationing of 4 necessary clinical activities.
  • These activities included patient/relative communication, treatment coordination, and documentation.
  • Higher caseloads, poor superior relationships, and heavy overall workload were significant predictors of implicit rationing.

Conclusions:

  • Implicit rationing jeopardizes critical services like patient orientation and professional cooperation, essential for effective mental healthcare.
  • Addressing workload and improving professional relationships may mitigate implicit rationing and enhance treatment quality.