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Biomedical subjects

Christiane Roick

Publications and source records attributed to Christiane Roick.

16 recordsLinked to original sources
PubMed2006

Validity of the EQ-5D in assessing and valuing health status in patients with schizophrenic, schizotypal or delusional disorders.

PURPOSE: The EQ-5D is a generic questionnaire generating a health profile and a single index score for health-related quality of life. This study aimed to analyse the discriminative ability and validity of the EQ-5D in patients with schizophrenic, schizotypal or delusional disorders. SUBJECTS AND METHODS: One hundred sixty-six patients with schizophrenic, schizotypal or delusional disorders (ICD-10 F2) completed the EQ-5D. Measures of quality of life (WHOQOL-BREF), utility (TTO), subjective (SCL-90R) and objective (PANSS, CGI-S) psychopathology, and functioning (GAF, GARF, SOFAS, HoNOS) provided comparison. Discriminative ability was analysed by assessing frequency distributions of EQ-5D scores. Validity of the EQ-5D self-classifier was analysed by assessing differences in related other scores grouped by response levels of EQ-5D items. Validity of the visual analogue scale (EQ VAS) and the EQ-5D index (UK social tariff) was analysed by assessing their correlation with all other scores. RESULTS: Seventy-nine percent of respondents reported problems in at least one of the EQ-5D dimensions (anxiety/depression 57%, usual activities 45%, pain/discomfort 44%, self-care 29%, mobility 22%). The mean EQ VAS score/EQ-5D index was 65.7/0.71. The four most frequently reported EQ-5D health states covered 45% of all respondents. For almost all EQ-5D dimensions, different response levels were associated with significantly different scores of measures used for comparison. Correlation of EQ VAS score and EQ-5D index were largest with scores of subjective measures (SCL-90R: -0.50 and -0.73; WHOQOL mental subscore 0.62 and 0.58; always P<0.001). DISCUSSION AND CONCLUSION: The EQ-5D showed a moderate ceiling effect and seems to be reasonably valid in this patient group.

Adult↗
PubMed2006

The EQ-5D in alcohol dependent patients: relationships among health-related quality of life, psychopathology and social functioning.

OBJECTIVE: The EQ-5D, a short generic health-related quality of life (HRQOL) questionnaire, can derive preference-based index scores (e.g. EQ VAS, British and German EQ-5D indices) for economic evaluation. This study examined if the EQ-5D could be a valid measure describing and valuing HRQOL in alcohol dependent individuals. METHODS: In a sample of 103 individuals diagnosed with alcohol dependence (ICD-10 F10.2), we compared the EQ-5D against a quality of life measure (WHOQoL-BREF), a utility scale (TTO), measures of psychopathology (SCL-90R, CGI-S) and measures of social functioning (GAF, GARF, SOFAS, HoNOS). RESULTS: The response rate to EQ-5D dimensions was > 98%. Twelve percent of the individuals indicated "extreme problems" in at least one dimension. Different response levels in the dimension "anxiety/depression" were associated with largest effect sizes (absolute value(d)) of differences in mean scores of the WHOQoL-BREF domain "mental" (absolute value(d) = 1.17), the SCL-90R scales "obsessive-compulsive" (absolute value(d) = 1.15), "depression" (absolute value(d) = 1.16), "anxiety" (absolute value(d) = 1.10) and "GSI" (absolute value(d) = 1.09) indicating a similarity between the underlying constructs; concerning the dimensions "self-care", "usual activities", "pain/discomfort" and "mobility" effect sizes were generally lower (0.74 < absolute value(d) < 1.07) or insignificant. The EQ-5D VAS score (mean 58.0), the British EQ-5D index (mean 0.74) and the German EQ-5D index (mean 0.85) showed moderate correlations with other scales (0.28 < r < 0.60). CONCLUSION: Seventeen out of 30 hypothesized relationships between similar constructs of the EQ-5D and measures used for comparison were confirmed, possibly favoring EQ-5D's validity. However, the EQ-5D showed a moderate ceiling effect. Further confirmatory research is needed to support the EQ-5D suitability for economic evaluation in alcohol dependent populations.

Activities of Daily Living↗
PubMed2006

[Medical journals for authors and/or readers? Opinions of different reader groups about the journal "Psychiatrische Praxis"].

OBJECTIVE: Do readers, who are themselves also authors of scientific publications, have different opinions regarding the conception of medical journals than pure readers? METHODS: A survey among readers of the journal "Psychiatrische Praxis" (PP) with 49 participants (22 themselves authors, 27 pure readers) was analysed. RESULTS: Authors and pure readers have similar reading habits and agree on their evaluation of most criteria of a medical journal. However, authors care more about a journal's listing in international databases and pure readers more about its practical orientation. Case reports are highly appreciated by pure readers and little by authors. Authors favour the topics social psychiatry, health care provision, prevention/rehabilitation; and pure readers general psychiatry/psychiatry/basics, clinical psychiatry and psychotherapy. Authors evaluate the PP more positive than pure readers. CONCLUSIONS: It is a challenge for journal editors and editorial staff to meet not only the authors' expectations, but also those of the pure readers.

Adult↗
PubMed2005

[The regional budget for mental health care: a new approach to combine inpatient and outpatient care].

OBJECTIVE: Due to increasing health care expenditures the discussion about advantages and disadvantages of new methods for resource allocation in mental health care has been intensified. A promising model is the Regional Budget for Mental Health Care, which is currently being examined in Schleswig-Holstein. The present paper describes first experiences with the new resource allocation model. BASIC CONDITIONS: An annual budget, provided for the treatment of a fixed number of patients, makes it possible to reduce inpatient capacity in favour of improved community-integrated approaches for the treatment of acute psychiatric illness. RESULTS: In a first step inpatient capacity will be reduced by 8 percent. By the end of 2007 capacity for hospital day care shall be increased by 87 percent and a home treatment will be implemented. The previous working method, orientated to treatment setting, will be replaced by an approach specialized in diagnostic groups. CONCLUSIONS: The Regional Budget could improve the continuity and flexibility of patient care. Service providers become motivated to treat in a way, which with little resource consumption achieves a long lasting health status improvement. For health insurances the Regional Budget is an opportunity to limit cost increases.

Ambulatory Care↗
PubMed2004

Factors contributing to frequent use of psychiatric inpatient services by schizophrenia patients.

BACKGROUND: Although present findings about frequent users of psychiatric inpatient services vary from study to study, some potentially important predictors of frequent use were extracted. The purpose of this study was to examine the potentially contributory factors of frequent use of psychiatric inpatient services by schizophrenia patients and to test the influence single factors have in an overall model. METHODS: A total of 307 schizophrenia patients were interviewed five times with intervals of 6 months. Data were collected about service receipt and health care costs, strength of primary diagnosis and comorbidities, as well as about patients' needs for care and satisfaction with care. Patients with three or more psychiatric admissions within a 30-month period were defined as frequent users. RESULTS: According to this criterion, 12% of the study population were frequent users. Compared with ordinary users, these patients accounted for significantly higher costs in hospital- and community-based care. Important predictors for frequent use of psychiatric inpatient services were the number of previous hospitalizations and current scores of psychopathology. In addition, a longitudinal analysis showed the importance of social factors for the use of psychiatric inpatient care. Therefore, a number of the frequent users' multiple admissions could also be caused by social problems. CONCLUSIONS: The mental health system should, thus, provide well-directed community-based resources, which give frequent users support to solve their social problems.

Adolescent↗
PubMed2004

[Quality of life instruments and health state preferences to assess effects of medical interventions for mentally and medically ill patients].

AIM: The assessment of quality of life with a single index, which is necessary for cost-utility analyses, causes a loss of information. Therefore the suitability of such indices for mental health and non-mental health conditions was analysed and their ability to detect effects of medical interventions was examined. METHOD: Quality of life of 18 schizophrenic patients and 26 patients with diabetes mellitus was rated three times using disease specific instruments (BELP-KF, DMLQ), visual analog scale (VAS), EQ-5D and time trade-off (TTO). RESULTS: Effects of medical interventions were only detected with the disease specific instruments and EQ-5D. Using TTO and EQ-5D, there were significant, but reverse differences in the quality of life of patients with diabetes and patients with schizophrenia. EQ-5D correlated highly with DMLQ, but lowly with BELP-KF. CONCLUSIONS: TTO and VAS were insensitive to effects of medical interventions. EQ-5D detected treatment-induced changes, but was inappropriate as a measure of quality of life in schizophrenic patients.

Attitude to Health↗
PubMed2004

[Frequent use of psychiatric inpatient services analysed from three different perspectives].

OBJECTIVE: Frequent utilization of psychiatric inpatient care was mainly analysed by quantitative methods. The present study combines quantitative with qualitative methods and discusses the results obtained from these different perspectives. METHOD: The quantitative analysis is based on data from 184 schizophrenia patients, who were observed over a period of 2(1/2) years. Twenty of the identified frequent users and 6 employees of psychiatric facilities were interviewed by means of qualitative methods as to the causes of frequent use of inpatient care. RESULTS: Predictors of frequent use identified in the quantitative study were found again in the qualitative analysis. Opportunities for alternative care for frequent users suggested by the staff of psychiatric facilities include social treatment in the community, day structuring activities and sheltered work. Patients consider work, compliance securing and better contact with office based psychiatrists to be important factors. CONCLUSIONS: Patients and staff give different priorities to their suggestions for interventions, but are, in most cases, of the opinion, that part of hospital admissions of frequent users could be avoidable by means of alternative services.

Adolescent↗
PubMed2004

[Social psychiatry without sociology. Analysis of a scientific journal].

AIM: Psychiatry and Sociology have followed separate avenues in Germany since the mid 1970 s. The aim of this work is to investigate their present relationship by means of an analysis of a scientific journal. METHOD: All original works dealing with social psychiatric subjects and appearing in Psychiatrische Praxis in the years 2002 and 2003 were analysed. RESULTS: Sociologists appear to be a minority among the authors. Questions that are explicitly related to sociological theories were an exception, and sociological authors have hardly been quoted. CONCLUSION: Social psychiatric research in Germany is still conducted without Sociology. If social psychiatry is to gain in importance as a scientific discipline, closer cooperation with its mother discipline is imperative. As an example, the application of the rational choice theory in psychiatric research is discussed.

Community Psychiatry↗
PubMed2002

[Heavy users of inpatient psychiatric services].

OBJECTIVE: This paper describes the extent of heavy use of inpatient psychiatric services. It reveals predictors of heavy use. METHODS: 969 users of inpatient psychiatric services in the city of Leipzig were identified based on health insurance data. RESULTS: 16,7 % of the patients had at least 3 admissions and were classified as heavy users. They accounted for 36,4 % of the total inpatient cost. Patients suffering from schizophrenia or a comorbidity with personality disorders had a higher risk to be a heavy user. The kind of facility and the way of discharge were also predictors for heavy use. CONCLUSIONS: Further qualitative analyses should identify reasons for heavy users to utilize inpatient services and find out other opportunities of care for these patients.

Adolescent↗
PubMed2002

[Heavy users of psychiatric care].

OBJECTIVE: This paper reviews findings and problems of heavy users research. METHODS: The German- and English language literature about "heavy users" and relevant border areas was analyzed. RESULTS: Heavy users are patients who consume a disproportionate share of medical services. The characteristics of heavy users are inhomogeneous. Social problems, denial of illness, non-compliance, comorbid personality disorders and substance misuse contribute significantly to heavy use. Future studies should define heavy use illness-related. More research is needed to clarify whether heavy use of special services is adequate to the patients situation. CONCLUSIONS: Heavy users should be identified early, in order to offer them alternative services, which better fulfil the patients specific conditions and prevent an inadequate heavy use of expensive services.

Case Management↗
PubMed2002

A comparison of methods to handle skew distributed cost variables in the analysis of the resource consumption in schizophrenia treatment.

BACKGROUND: Transformation of the dependent cost variable is often used to solve the problems of heteroscedasticity and skewness in linear ordinary least square regression of health service cost data. However, transformation may cause difficulties in the interpretation of regression coefficients and the retransformation of predicted values. AIMS OF THE STUDY: The study compares the advantages and disadvantages of different methods to estimate regression based cost functions using data on the annual costs of schizophrenia treatment. METHODS: Annual costs of psychiatric service use and clinical and socio-demographic characteristics of the patients were assessed for a sample of 254 patients with a diagnosis of schizophrenia (ICD-10 F 20.0) living in Leipzig. The clinical characteristics of the participants were assessed by means of the BPRS 4.0, the GAF, and the CAN for service needs. Quality of life was measured by WHOQOL-BREF. A linear OLS regression model with non-parametric standard errors, a log-transformed OLS model and a generalized linear model with a log-link and a gamma distribution were used to estimate service costs. For the estimation of robust non-parametric standard errors, the variance estimator by White and a bootstrap estimator based on 2000 replications were employed. Models were evaluated by the comparison of the R2 and the root mean squared error (RMSE). RMSE of the log-transformed OLS model was computed with three different methods of bias-correction. The 95% confidence intervals for the differences between the RMSE were computed by means of bootstrapping. A split-sample-cross-validation procedure was used to forecast the costs for the one half of the sample on the basis of a regression equation computed for the other half of the sample. RESULTS: All three methods showed significant positive influences of psychiatric symptoms and met psychiatric service needs on service costs. Only the log- transformed OLS model showed a significant negative impact of age, and only the GLM shows a significant negative influences of employment status and partnership on costs. All three models provided a R2 of about.31. The Residuals of the linear OLS model revealed significant deviances from normality and homoscedasticity. The residuals of the log-transformed model are normally distributed but still heteroscedastic. The linear OLS model provided the lowest prediction error and the best forecast of the dependent cost variable. The log-transformed model provided the lowest RMSE if the heteroscedastic bias correction was used. The RMSE of the GLM with a log link and a gamma distribution was higher than those of the linear OLS model and the log-transformed OLS model. The difference between the RMSE of the linear OLS model and that of the log-transformed OLS model without bias correction was significant at the 95% level. As result of the cross-validation procedure, the linear OLS model provided the lowest RMSE followed by the log-transformed OLS model with a heteroscedastic bias correction. The GLM showed the weakest model fit again. None of the differences between the RMSE resulting form the cross- validation procedure were found to be significant. DISCUSSION: The comparison of the fit indices of the different regression models revealed that the linear OLS model provided a better fit than the log-transformed model and the GLM, but the differences between the models RMSE were not significant. Due to the small number of cases in the study the lack of significance does not sufficiently proof that the differences between the RSME for the different models are zero and the superiority of the linear OLS model can not be generalized. The lack of significant differences among the alternative estimators may reflect a lack of sample size adequate to detect important differences among the estimators employed. Further studies with larger case number are necessary to confirm the results. IMPLICATIONS: Specification of an adequate regression models requires a careful examination of the characteristics of the data. Estimation of standard errors and confidence intervals by nonparametric methods which are robust against deviations from the normal distribution and the homoscedasticity of residuals are suitable alternatives to the transformation of the skew distributed dependent variable. Further studies with more adequate case numbers are needed to confirm the results.

Adolescent↗