Search PubMed⌕ Search

Biomedical subjects

Martin Härter

Publications and source records attributed to Martin Härter.

At least 19 recordsLinked to original sources
PubMed2005

[Bronchial asthma and mental disorders -- a systematic review of empirical studies].

Bronchial asthma occurs independently from gender and in all age groups belonging to the frequent diseases with a high demand for treatment. A part of those affected suffer from comorbid mental burden and disorders. The review analyses studies investigating the prevalence of mental burden and disorders in patients with bronchial asthma. The database MEDLINE was searched for studies published from 1980 to 2002. Patients with bronchial asthma frequently show mood and anxiety disorders, with prevalence rates up to 41 % and 52 %. There is no significant correlation between the severity of asthma and the existence of a mental burden or disorder. However, persons with difficult-to-treat asthma (brittle asthma) show more mental burden than patients with controllable symptoms. Compliant patients show a lower prevalence rate of depressive burden than noncompliant patients. The reviewed studies are very heterogeneous with respect to their methodology and the investigated samples limiting the interpretation of their results significantly. In the future more well-designed epidemiological studies have to be performed to achieve valid and representative conclusions about the prevalence rates of mental burden and disorders in patients with bronchial asthma.

Asthma↗
PubMed2004

Depressive symptom patterns and their consequences for diagnosis of affective disorders in cancer patients.

GOALS OF WORK: In order to obtain references for adequate diagnostic procedures of depressive syndromes in cancer patients, the present study analyzes first the prevalence of somatic, emotional, and cognitive symptoms of depression. In a second part, the ability of diagnostic procedures to discriminate between patients with and without comorbid affective disorder is investigated. PATIENTS AND METHODS: From a cross-sectional survey investigating comorbid mental disorders in cancer patients with standardized clinical assessment, a subsample of 71 patients with current affective disorders and depressive symptoms according to the Diagnostic and Statistic Manual of Mental Disorders, 4th edition (DSM-IV) were analyzed. In addition to patients' symptom patterns, a discriminant analysis including all depressive symptoms was conducted. MAIN RESULTS: Cognitive symptoms are less prevalent in cancer patients than somatic and emotional symptoms. Loss of interest discriminated best between patients with and without diagnosis of comorbid affective disorder. Additionally, decreased energy and fatigue proved to have discriminatory value. CONCLUSIONS: Cognitive symptoms should receive special attention in diagnostic procedures for affective disorders in cancer patients. In spite of possible symptom overlap with the cancer disease and its treatment, fatigue proves to be a useful criteria for diagnosis of depression.

Adult↗
PubMed2004

Recognition of psychiatric disorders in musculoskeletal and cardiovascular rehabilitation patients.

OBJECTIVE: To investigate the detection rate of psychiatric disorders in rehabilitation inpatients with musculoskeletal and cardiovascular diseases (CVDs). DESIGN: Cross-sectional survey; analysis of medical charts and discharge reports, combined with standardized diagnostic interviews. SETTING: Four orthopedic and 6 cardiovascular rehabilitation hospitals in southwest Germany. PARTICIPANTS: More than 1700 inpatients with different musculoskeletal disorders and CVDs participated in the survey. On the basis of their General Health Questionnaire score, 205 patients with musculoskeletal diseases and 164 patients with CVDs were selected randomly for standardized interviews. Discharge reports of interviewed patients were analyzed. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical interview (Composite International Diagnostic Interview [CIDI]) to obtain diagnoses of psychiatric disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Assessment of psychosocial burden and diagnoses of mental disorders, as well as admission to psychologic treatments, based on discharge reports of the attending physicians. RESULTS: The detection rate (sensitivity) of mental disorders was 48% in the orthopedic rehabilitation patients and 32% in the cardiovascular patients. Specificity was 80% in musculoskeletal patients and 87% in cardiovascular patients. Differential diagnostic competencies were lacking, and only half of the physicians' diagnoses corresponded to the CIDI diagnoses. CONCLUSIONS: The results showed a need for current DSM-IV or International Classification of Diseases, 10th edition, psychodiagnostics in medical rehabilitation to detect mental disorders in patients in the rehabilitation process at an earlier stage and to refer patients with comorbid mental disorders to adequate treatment.

Adult↗
PubMed2004

Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care.

Somatic symptoms and anxiety symptoms are often disregarded in the detection of depression in primary care. The present investigation examined to what extent somatic and anxiety symptoms recorded with the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC) can improve the detection of depression as compared to the General Health Questionnaire-12-item version alone. Data from the World Health Organization study on Psychological Problems in General Health Care were used. The study sample consisted of primary care attenders from 15 centres from all over the world who underwent a psychiatric examination with the CIDI-PHC. Medically unexplained somatic symptoms (back pain, feelings of heaviness/lightness in parts of the body, periods of bodily weakness, seizures/convulsions, permanent tiredness, exhaustion after a minimum of effort) and-to a smaller extent-diverse anxiety symptoms (e.g. feelings of anxiousness/nervousness, feelings of tension, difficulties relaxing) significantly contributed to the detection of depression in a logistic regression analysis. The results confirm the observation that in primary care somatic symptoms play an important role in the manifestation of depressive disorders. The items investigated herein could prove beneficial for future depression screening instruments to improve the detection of depressive disorders in primary care.

Anxiety Disorders↗
PubMed2004

[Cost of care for depressive disorders in primary and specialized care in Germany].

Service utilization and total direct cost of care was assessed in 270 patients suffering from depressive disorder. Patients were recruited from primary care physicians or family doctors (n = 43) or psychiatrists (n = 23) in office practice, from three different regions in Germany (county of Düren and city of Aachen, Lörrach-county, city of Munich). A detailed catalogue of unit costs (including inpatient, outpatient and rehabilitative services) was used for calculating total cost of care on an individual basis. Service utilization and costs referred to 2001. Mean cost of total medical care of the study patients was euro 3849 (excluding cost of drugs for physical illness). The cost for treating depressive disorders and additional psychiatric co-morbidity (which is included into the total cost of care) was euro 2073 per patient and year. When cross-checking with ICD-10 criteria for depressive disorders, the original diagnosis by family doctors or psychiatrists could be confirmed in 186 patients of the total sample (n = 270), suggesting that there is a high amount of falsely diagnosed patients in primary and specialized care of depressive patients in Germany. Direct cost of the 186 confirmed patients was higher (total care cost: euro 4715, cost for treatment of depression and psychiatric co-morbidity: euro 2541) than in the total group and should be considered as reference cost, when discussing cost of care in depressive patients in Germany. Results suggest to analyse cost of care in depressive patients further and to discuss a more efficient allocation of health budgets in the field.

Adult↗
PubMed2004

[Information and participation interests of patients with depression in clinical decision making in primary care].

A main flaw in the primary care of depression is the patients' skepticism about adequate treatment. Despite effective treatment options patients' medical demand is poor and their information insufficient. The present study aims to improve patients' information and their participation in decision making to enhance treatment motivation and satisfaction with treatment and clinical outcome. It is unclear, though, if patients are able to show interest in information and participation because of depression-specific deficits (e.g. an impairment of cognition and concentration). In a controlled study 232 patients with depression from 30 GP practices completed questionnaires assessing information and participation needs. Patients with all severity grades of depression are highly interested in information (mean = 85.2; range 0-100) and moderately interested in participating in decision making (mean = 46.8; range 0-100). Perceived involvement in care achieved a mean of 68.4 (range 0-100). The implementation of shared decision making in the primary care of depressive patients is reasonable and will be realised and evaluated within the scope of a targeted continuing education program for general practitioners.

Depression↗
PubMed2004

[Measuring shared decision making].

Since October 2001 the German Ministry of Health and Social Security has been funding 10 projects to introduce shared decision making in clinical practice. A national meeting was held on assessment procedures to achieve consensus on a core set of instruments for the measurement of process and outcome of shared decision making. Project collaboration is co-ordinated through the methodological centre in Freiburg. Currently there are no validated measuring instruments available for German-speaking countries. Thus four international questionnaires were translated into German. In a second step the questionnaires were validated on a sample of 646 patients across 10 different diseases. To this purpose, the data of these 10 projects were combined in one database. Comprehensibility of the questionnaires used was checked in patient interviews. Moreover, the semantic structure of the questionnaires was tested by the Centre for Surveys. Methods and Analyses (ZUMA) in Mannheim. The results of this assessment process point towards problems of both comprehensibility and lack of specification of reference points for clinical decision. The statistical results for two of these questionnaires deviate from previous studies. These data indicate a potential for improving the instruments currently used for shared decision making. Separate validation across different languages and health care systems is needed in the field of shared decision making. Further research efforts on the methodological field now focus on the integration of these results with a new measuring instrument and the validation of this tool.

Germany↗
PubMed2003

[Chronic diseases, psychological distress and coping -- challenges for psychosocial care in medicine].

Due to the increase of chronic diseases within the last decades the need and demand for psychosocial treatment in medicine has been realized. This review focuses on the psychosocial aspects of chronic diseases and discusses selected topics of medical and rehabilitation psychology. Recent developments in quantitative and qualitative methods have allowed the systematic analysis of psychosocial distress and coping with chronic disease as well as the consequences on social relationships. The need for psychosocial treatment in acute care and rehabilitation can be diagnosed by differential assessment tools for coping and psychiatric morbidity. Specific approaches of psychology and psychotherapy for patients with somatic diseases have been developed and may be regarded as an integrative part of medical treatment in acute care and rehabilitation. In rehabilitation, the traditional individualistic view of psychotherapy has been broadened towards vocational integration and participation in social activities as outcome criteria. Evaluation research as well as the rehabilitation sciences have provided empirical data on psychosocial treatment of chronically ill patients. Under increasing financial restrictions and problems of the health care systems there is a need for quality assurance and the proof of scientific evidence to guarantee psychosocial treatment as an integrated part of medical care in the future.

Adaptation, Psychological↗
PubMed2003

[Comprehensive ambulatory care quality management for patients with depressive disorders].

Depressive disorders are of great medical and political significance. Despite improvements in the treatment of depressive patients, the potential for guideline-oriented diagnosis and therapy as well as better co-operation between different levels of care is evident. This study is part of the German Research Network on Depression and Suicidality. The study is conducted in Southern Baden, North Rhine and Munich. The objective is to develop a quality management program for primary care physicians and psychiatrists. A comprehensive continuous medical education concept as well as quality management measures were developed, implemented and evaluated. A total of 66 physicians (43 primary care physicians and 23 psychiatrists) participated. They documented the diagnostic and treatment measures provided to depressive patients before and after the intervention that had been implemented in the intervention regions of Southern Baden and North Rhine. Effects regarding guideline orientation and implementation of stepped-care treatment are analysed with an intervention/control group design and prepost data measurement.

Ambulatory Care↗
PubMed2003

[Clinical practice guidelines for the diagnosis and therapy of depressive disorders in primary care].

The guidelines for diagnosis and treatment of depressive disorders are practice-oriented and evidence-based recommendations for primary care of depressive patients. They were developed in the context of subproject 3.1 "Comprehensive Quality Management in Outpatient Care" within the German Research Network on Depression and Suicidality. The guidelines were developed by research groups from study centres in Freiburg, Duesseldorf and Munich and an external expert group. In addition, a close co-operation was established with the Guideline Clearing Commission of the Agency for Quality in Medicine (AQuMed) and the Drug Commission of the German Medical Profession (AkdA) and are intended as an orientational aid in terms of a "pathway of care". The guidelines particularly address physicians in primary care. The development process followed the methodological recommendations of the Association of the Scientific Medical Societies in Germany (AWMF) and the requirements of evidence-based medicine. National and international guidelines for depressive disorders as well as Cochrane reviews (CR) and quality-assessed reviews (CRD) were taken into account. The present formulation of the treatment guidelines and the evidence was agreed upon in a consensus process that included all participants.

Depressive Disorder↗
PubMed2003

[Development and evaluation of a basic documentation tool for guideline-oriented ambulatory care of depressive patients].

Quality assurance in the treatment of mental disorders is becoming increasingly significant. In this context, documentation systems are important in order to control the implementation of guidelines, to analyse shortcomings and to reveal improvement possibilities. Up till now there is no specific documentation tool for the outpatient care of depressive disorders. Within the project "Comprehensive Quality Management in Out-patient Care" a documentation tool for primary care as well as for psychiatric care of depressive patients has been developed, which embraces the principal diagnostic and therapeutic measures. This documentation tool consisting of an instrument for the physician to record the first consultation, a second instrument to record the following consultations as well as a patient questionnaire has been implemented and evaluated in primary care and psychiatric practices. The evaluation results demonstrate that the documentation tool is able to assess guideline-oriented treatment measures. Physicians evaluated the usefulness and practicability of the documentation tool positively. And although the documentation efforts required are quite extensive, this documentation tool provides a suitable basis for external or internal quality assurance as well as patient-oriented case-monitoring.

Ambulatory Care↗
PubMed2003

[Agreement in physicians' and patients' assessment of depressive disorders].

Depression is one of the most frequently encountered mental health disorders in primary care. The health and financial burden caused by this disorder emphasise the clinical importance of depressive disorders. Research shows that these conditions often remain unrecognised and untreated. The aim of this study is to analyse if and how primary care physicians identify this condition in comparison to the patients' self-evaluation. A total of 1,233 cases in 32 primary care physicians' offices were examined to see if symptoms of depression were recognised. The assessment procedures were evaluated, too. In this study, the prevalence of depressive disorders was 10%, and the recognition rate of primary care physicians 45%. These results underscore the importance of improving physicians' recognition of depression and use of ICD-10 criteria for differential diagnosis. Conclusions must be drawn for a specific training of primary care physicians that focuses on the improvement of diagnosis and treatment of depressed patients.

Depressive Disorder↗
PubMed2003

[Reason for encounter and diagnosis of depression in patients in general practice].

The present study investigates the extent to which the physicians' diagnosis of depression was influenced by the reason that patients gave for seeking help, i.e. the reason for encounter. The level of correspondence between the somatic diagnoses of 20 GPs and the self-ratings of 862 patients from the regions of North Rhine and Southern Baden in regard to the presence of a depressive syndrome was recorded. In addition to the somatic diagnosis of depression (yes/no), the reason for encounter as well as primary and secondary diagnoses of the participating GPs were also documented. The results show that approximately 10% of the GPs' patients judged themselves to be depressed and that in these patients, the GPs diagnosed depression in only 39% of cases. This low level of correspondence between physician and patient in regard to depression can be accounted for by the finding that first, there is little difference between depressed and non-depressed patients in the manner in which they distinguish themselves in regard to their reason for encounter and that second, depressed patients expressed more somatic (57%) than mental symptoms (20%). A depressive disorder was only reported for 5% of the patients who had judged themselves to be depressed. On the whole, the results have shown that the reasons for seeking treatment expressed by patients had a significant influence on correspondence between the physician and patient: for patients who had been judged by a physician and themselves to be depressed, mental complaints (34%) were more likely to be reported than for patients who had not been diagnosed with depression by their GPs (10%). Additional questions addressed to the physicians revealed that they were more likely to diagnose depression on the basis of the patients' self-ratings and behaviour than to routinely question the patients for symptoms of depression. Hence, the study underlines the need for training in criteria-orientated diagnosis and the application of suitable screening instruments for depressive disorders in general practice.

Depressive Disorder↗
PubMed2003

[Subjectively-perceived inappropriate treatment of depressed patients in general and psychiatric practice].

In the present study, process quality in outpatient depression care was documented by general practitioners and specialists in psychiatry. Opportunities to improve inpatient treatment were identified by comparing current physicians' treatment procedures with guideline recommendations and, furthermore, by evaluating treatment outcomes from the patients' perspective. Data of 350 depressed outpatients were collected by 43 GPs and 23 specialists in psychiatry in three study regions (Rhineland, South Baden and Munich). Data reflected psychopathology, diagnostic assessment, investigation of suicidal intentions as well as somatic and psychotherapeutic measures at the first visit. Additionally, change in depression symptoms after six to eight weeks by means of self-rating (n = 165) and expert rating (n = 70) was measured. The study shows that the GPs and, to a lesser extent, the specialists, still fail to orient themselves towards guideline recommendations regarding assessment, therapy and referral in depression care. These findings seem to be reflected in insufficient self rated treatment outcome: one half of the patients reported a reduction in depression symptoms, the other half of patients reported stagnation or even progression. Expert ratings of treatment courses were more positive. The results indicate a considerable need for guideline training and improvement of networking and co-operation between GPs and specialists as well as between inpatient and outpatient settings.

Depressive Disorder↗
PubMed2003

[Continuing education and quality management measures for the implementation of clinical practice guidelines].

In the past years it could be shown that evidence-based guideline-oriented treatment of depressive patients leads to better diagnosis, to more adequate therapy and to better networking of the different levels of care. And yet, guidelines have been rarely used. On the other hand, better short-dated support of depressive patients is achievable by medical education. But to ensure the application of guidelines in the long term, it is necessary to consider individual practice and local/regional conditions. There is a need for interactive and experience-oriented educational concepts. The present educational concept of "Out-patient Depression Management" has been developed as part of the "Comprehensive Quality Management in Out-patient Care" project and implemented in two study regions of Southern Baden and North Rhine. The depression management concept was designed as a combination of interactive, guideline-oriented continuous medical education with interdisciplinary quality circles. The evaluation of the depression management concept shows very positive ratings from both primary care physicians and psychiatrists: 70% of the primary care physicians and 83% of the psychiatrists were satisfied or much satisfied with the program. 70% of the primary care physicians and 50% of the psychiatrists evaluated the usefulness for practice as good or very good.

Depressive Disorder↗
PubMed2003

[Cost optimization of the outpatient management of depression].

Against the background of the important role of depressive disorders in health policy, outpatient management still seems to have some optimisation potential. In particular, improvement can be expected from a stricter adherence to diagnostic and therapeutic guidelines. The article discusses potential elements of a quality-orientated, guideline-based reimbursement system as a component of a comprehensive strategy for implementing available guidelines. This includes focussing on target areas typical of depression as well as improving outcome by controlling process elements during treatment.

Ambulatory Care↗
PubMed2002

A descriptive study of psychiatric disorders and psychosocial burden in rehabilitation patients with musculoskeletal diseases.

OBJECTIVE: To investigate current, 12-month, and lifetime prevalence rates, and associated psychosocial burden of psychiatric disorders in rehabilitation inpatients with musculoskeletal diseases. DESIGN: Two-stage epidemiologic survey. SETTING: Four orthopedic rehabilitation inpatient clinics in southwest Germany. PARTICIPANTS: A total of 910 inpatients with different musculoskeletal diseases participated in the survey. According to their General Health Questionnaire-12 scores, 205 patients were selected randomly for standardized interviews. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Psychosocial burden (Hospital Anxiety and Depression Scale, Lübeck Alcoholism Screening Test) and quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey), assessment of diagnosis and somatic parameters through standardized medical records. Clinical interview (Munich Composite International Diagnostic Interview) in the second-stage examination to obtain Diagnostic and Statistical Manual of Mental Disorders (4th edition) diagnoses of psychiatric disorders. RESULTS: Prevalence rates of psychiatric disorders are 31.1% for the 4-week period, 47.1% for the 12-month period, and 64.6% for the lifetime period. The most prevalent current disorders are anxiety (15%), affective (10.7%), and substance-related disorders (9.2%). Half of the comorbid ill patients have 2 or more simultaneous psychiatric disorders and report elevated levels of psychosocial burden (eg, intense pain, low quality of life, more days of sick leave). CONCLUSIONS: Patients undergoing musculoskeletal rehabilitation should be assessed carefully for comorbid psychiatric illnesses. Further research should be undertaken to evaluate the effectiveness of psychosocial interventions for comorbid psychiatric disorders on life quality, therapeutic compliance, and outcome of rehabilitation treatment.

Adult↗