Table 1 Differences between components of interventions
Usual care | General practitioners program | PNP program | |
|---|---|---|---|
Requirements for participation (patients) | - free choice of health care providers with a license in Baden-Wuerttemberg | - minimum time of participation: 12 months - commitment to seek help from GPs enrolled in the program only - commitment to seek help from GPs first (exception: emergencies, gynecologist, ophthalmologists, pediatricians) | - enrolled in the general practitioners program and the specialist program - minimum time of participation: 12 months - commitment to seek help from health care providers enrolled in the program only - commitment to seek help from GPs first (exception: emergencies, gynecologist, ophthalmologists, pediatricians) |
Requirements for participation (health care providers) | - license in Baden-Wuerttemberg | - license in Baden-Wuerttemberg - GP | - license in Baden-Wuerttemberg - psychotherapists and specialists in psychiatry, neurology, psychotherapy, or psychosomatic medicine - enrolment in at least one of three modules: psychiatry, neurology, psychotherapy |
Role of GPs | - diagnosis, treatment, referral to specialists | - diagnosis, treatment, referral to specialists - guiding through care: structured coordinating and communication to specialists care and merging results of medical examinations | - diagnosis, treatment, referral to specialists - guiding through care: structured coordinating and communication to specialists care and merging results of medical examinations |
All providers | |||
Compensation and diagnoses | - health care services for patients with specific and unspecific diagnoses in accordance with ICD-10 are billable | - health care services for patients with specific and unspecific diagnoses in accordance with ICD-10 are billable - fee for cooperation with specialists | - health care services for patients with predominantly specific diagnoses in accordance with ICD-10 are billable (e.g., for depressive disorders, only the specific codes F32.0-F32.3, F33.0-F33.4 are billable; the unspecific codes F32.8, F32.9, F33.8, and F33.9 are not billable) - fee for cooperation with specialists and GPs |
Social service | - social service of the AOK Baden Wuerttemberg | - more structured cooperation between health care provider and social service of the AOK Baden Wuerttemberg | - more structured cooperation between health care provider and social service of the AOK Baden Wuerttemberg |
Quality management | - mandatory continuous training courses | - mandatory continuous training courses - participation in quality circles on drug therapy (once per quarter) for GPs | - mandatory continuous training courses - participation in quality circles on drug therapy (once per quarter) for GPs (optional for specialists) |
Psychotherapy | |||
Differences in compensation | - higher payment of regular sessions compared to preparatory sessions (2–4 preparatory sessions) | - higher payment of regular sessions compared to preparatory sessions (2–4 preparatory sessions) | - higher payment for first sessions (acute / initial care = 10/20 sessions) compared to long-term therapy and compared to usual care - higher payment for group psychotherapy compared to usual care - collective incentives for saving sickness benefits |
Organization | - review process for approval of long-term psychotherapy | - review process for approval of long-term psychotherapy | - no review process for approval of long-term psychotherapy |
Treatment content | - Cognitive Behavioral Therapy - Psychodynamic Psychotherapy - Psychoanalytic therapy - Neuropsychological therapy - Hypnosis - Eye Movement Desensitization and Reprocessing (EMDR) | - Cognitive Behavioral Therapy - Psychodynamic Psychotherapy - Psychoanalytic therapy - Neuropsychological therapy - Hypnosis - Eye Movement Desensitization and Reprocessing (EMDR) | - Cognitive Behavioral Therapy - Psychodynamic Psychotherapy - Psychoanalytic therapy - Additional treatment methods depending on diagnosis: ○ Neuropsychological therapy ○ Hypnosis ○ Eye Movement Desensitization and Reprocessing (EMDR) ○ Systemic psychotherapy ○ Biofeedback ○ Interpersonal therapy |
Additional guidelines on accessibility | / | / | - for acute cases: initial session within 3 days; start of psychotherapy within 7 days after established diagnosis - for initial treatment: start of psychotherapy within 4 weeks after established diagnosis |
Psychiatry | |||
Additional compensation | / | / | - additional supplements for → counselling (e.g. supportive counselling for patients with depression) → provision of technical equipment → prescription of discounted medication → collective incentives for the prevention of hospital admissions |
Additional guidelines on accessibility | / | / | - limit of waiting time up to 30 min - for acute cases: first doctor’s appointment within the same day |
Neurology | |||
Additional compensation | / | / | - additional supplements for → counselling (e.g. Multiple Sclerosis counselling: 6 units of 20 min per year) → provision of assistants (e.g. with special training on Multiple Sclerosis care) |
Additional guidelines on accessibility | / | / | - limit of waiting time up to 30 min - for acute cases: first doctor’s appointment within the same day |