Equal access to outreach mental health care? Exploring how the place of residence influences the use of intensive home treatment in a rural catchment area in Germany
Abstract Background Internationally, intensive psychiatric home treatment has been increasingly implemented as a community-based alternative to inpatient admission. Since 2018, the so-called Inpatient Equivalent Home Treatment (IEHT; German: "Stationsäquivalente Behandlung", short: "S...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-022-04477-y |
| _version_ | 1797973584037019648 |
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| author | Julian Schwarz Jan Hemmerling Nadja Kabisch Laura Galbusera Martin Heinze Sebastian von Peter Jan Wolff |
| author_facet | Julian Schwarz Jan Hemmerling Nadja Kabisch Laura Galbusera Martin Heinze Sebastian von Peter Jan Wolff |
| author_sort | Julian Schwarz |
| collection | DOAJ |
| description | Abstract Background Internationally, intensive psychiatric home treatment has been increasingly implemented as a community-based alternative to inpatient admission. Since 2018, the so-called Inpatient Equivalent Home Treatment (IEHT; German: "Stationsäquivalente Behandlung", short: "StäB") has been introduced as a particularly intensive form of home treatment that provides at least one daily treatment contact in the service users’ (SU) home environment. Prior research shows that this can be challenging in rural catchment areas. Our paper investigates to which extent the location of the SU home location within the catchment area as well as the distance between the home and the clinic influence the utilisation of inpatient treatment compared to IEHT. Method Routine data of one psychiatric hospital in the federal state of Brandenburg in Germany were analysed for the observational period 07/2018–06/2021. Two comparison groups were formed: SU receiving inpatient treatment and SU receiving IEHT. The SU places of residence were respectively anonymised and converted into geo-coordinates. A geographic information system (GIS) was used to visualise the places of residence, and car travel distances as well as travel times to the clinic were determined. Spatial analyses were performed to show the differences between comparison groups. In a more in-depth analysis, the proximity of SU residences to each other was examined as an indicator of possible clustering. Results During the observational period, the location of 687 inpatient and 140 IEHT unique SU were mapped using the GIS. SU receiving treatment resided predominantly within the catchment area, and this proportion was slightly higher for SU receiving IEHT than for those treated in inpatient setting (95.3% vs. 84.7%). In the catchment area, the geographical distribution of SU place of residence was similar in the two groups. There was a general higher service provision in the more densely populated communities close to Berlin. SU with residence in peripheral communities were mainly treated within the inpatient setting. The mean travel times and distances to the place of residence only differed minimally between the two groups of SU (p < 0.05). The places of residence of SU treated with IEHT were located in greater proximity to each other than those of SU treated in inpatient setting (p >; 0.1). Conclusion In especially peripheral parts of the examined catchment area, it may be more difficult to have access to IEHT rather than to inpatient services. The results raise questions regarding health equity and the planning of health care services and have important implications for the further development of intensive home treatment. Telehealth interventions such as blended-care approaches and an increase of flexibility in treatment intensity, e.g. eliminating the daily visit requirement, could ease the implementation of intensive home treatment especially in rural areas. |
| first_indexed | 2024-04-11T04:05:29Z |
| format | Article |
| id | doaj.art-a9d197e09a3c4e709bf4b273f34ac665 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-04-11T04:05:29Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-a9d197e09a3c4e709bf4b273f34ac6652023-01-01T12:24:21ZengBMCBMC Psychiatry1471-244X2022-12-0122111010.1186/s12888-022-04477-yEqual access to outreach mental health care? Exploring how the place of residence influences the use of intensive home treatment in a rural catchment area in GermanyJulian Schwarz0Jan Hemmerling1Nadja Kabisch2Laura Galbusera3Martin Heinze4Sebastian von Peter5Jan Wolff6University Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Hospital RüdersdorfGeography Institute, Humboldt Universität zu BerlinInstitute for Physical Geography and Landscape Ecology, Leibniz University HannoverUniversity Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Hospital RüdersdorfUniversity Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Hospital RüdersdorfUniversity Clinic for Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Hospital RüdersdorfPeter L. Reichertz Institute for Medical Informatics of the TU Braunschweig and the Medical University HannoverAbstract Background Internationally, intensive psychiatric home treatment has been increasingly implemented as a community-based alternative to inpatient admission. Since 2018, the so-called Inpatient Equivalent Home Treatment (IEHT; German: "Stationsäquivalente Behandlung", short: "StäB") has been introduced as a particularly intensive form of home treatment that provides at least one daily treatment contact in the service users’ (SU) home environment. Prior research shows that this can be challenging in rural catchment areas. Our paper investigates to which extent the location of the SU home location within the catchment area as well as the distance between the home and the clinic influence the utilisation of inpatient treatment compared to IEHT. Method Routine data of one psychiatric hospital in the federal state of Brandenburg in Germany were analysed for the observational period 07/2018–06/2021. Two comparison groups were formed: SU receiving inpatient treatment and SU receiving IEHT. The SU places of residence were respectively anonymised and converted into geo-coordinates. A geographic information system (GIS) was used to visualise the places of residence, and car travel distances as well as travel times to the clinic were determined. Spatial analyses were performed to show the differences between comparison groups. In a more in-depth analysis, the proximity of SU residences to each other was examined as an indicator of possible clustering. Results During the observational period, the location of 687 inpatient and 140 IEHT unique SU were mapped using the GIS. SU receiving treatment resided predominantly within the catchment area, and this proportion was slightly higher for SU receiving IEHT than for those treated in inpatient setting (95.3% vs. 84.7%). In the catchment area, the geographical distribution of SU place of residence was similar in the two groups. There was a general higher service provision in the more densely populated communities close to Berlin. SU with residence in peripheral communities were mainly treated within the inpatient setting. The mean travel times and distances to the place of residence only differed minimally between the two groups of SU (p < 0.05). The places of residence of SU treated with IEHT were located in greater proximity to each other than those of SU treated in inpatient setting (p >; 0.1). Conclusion In especially peripheral parts of the examined catchment area, it may be more difficult to have access to IEHT rather than to inpatient services. The results raise questions regarding health equity and the planning of health care services and have important implications for the further development of intensive home treatment. Telehealth interventions such as blended-care approaches and an increase of flexibility in treatment intensity, e.g. eliminating the daily visit requirement, could ease the implementation of intensive home treatment especially in rural areas.https://doi.org/10.1186/s12888-022-04477-yHealth care accessHealth equityHome-treatmentCrisis resolution teamsOutreach careHealth care planning |
| spellingShingle | Julian Schwarz Jan Hemmerling Nadja Kabisch Laura Galbusera Martin Heinze Sebastian von Peter Jan Wolff Equal access to outreach mental health care? Exploring how the place of residence influences the use of intensive home treatment in a rural catchment area in Germany BMC Psychiatry Health care access Health equity Home-treatment Crisis resolution teams Outreach care Health care planning |
| title | Equal access to outreach mental health care? Exploring how the place of residence influences the use of intensive home treatment in a rural catchment area in Germany |
| title_full | Equal access to outreach mental health care? Exploring how the place of residence influences the use of intensive home treatment in a rural catchment area in Germany |
| title_fullStr | Equal access to outreach mental health care? Exploring how the place of residence influences the use of intensive home treatment in a rural catchment area in Germany |
| title_full_unstemmed | Equal access to outreach mental health care? Exploring how the place of residence influences the use of intensive home treatment in a rural catchment area in Germany |
| title_short | Equal access to outreach mental health care? Exploring how the place of residence influences the use of intensive home treatment in a rural catchment area in Germany |
| title_sort | equal access to outreach mental health care exploring how the place of residence influences the use of intensive home treatment in a rural catchment area in germany |
| topic | Health care access Health equity Home-treatment Crisis resolution teams Outreach care Health care planning |
| url | https://doi.org/10.1186/s12888-022-04477-y |
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