Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Feb 2011
[From clinical practice guidelines towards quality assurance].
Clinical practice guidelines have been introduced to assist decision making at the bedside of individual patients. Guidelines are also increasingly regarded as being an indispensable part of professional quality systems. ⋯ Quality indicators or performance measures based on guideline recommendations are necessary to evaluate the usefulness of guidelines and the appropriateness of healthcare delivery. Guideline recommendations are the tools for healthcare professionals to develop strategies for quality improvement in case deviations from desired processes or outcomes are identified by the measurement of quality indicators.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Jan 2011
[Psychological comorbidity. A challenge in acute care].
Comorbid mental disorders are common in patients with chronic conditions. It can be assumed that around 30% of all inpatients have some kind of mental disorder. Most frequent are depressive disorders, anxiety disorders, somatoform disorders, and addictive disorders. ⋯ However, despite its importance comorbid mental disorders are often not recognized or appropriately treated. Wherever possible, patients with psychological issues should be presented to a psychosomatic or psychiatric consultation-liaison service for further diagnosis and treatment. To treat patients with comorbid mental disorders, physicians must be well experienced in psychotherapeutic treatment and a collaborative interdisciplinary working environment must have been established.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Jan 2011
[Comorbidity of chronic somatic illness and psychological disorders. Problems in outpatient mental health care].
Especially when chronic, the presence of a somatic disorder is accompanied by various levels of psychological stress, which can range up to comorbidity with mental disorders. In addition, chronic somatic diseases and mental disorders are often interdependent. Treatment for persons with mental and somatic comorbidity is frequently offered in the context of medical rehabilitation. ⋯ In addition to the expert skills of psychotherapists, interprofessional training, basic knowledge, and communication with physicians are necessary. The present article outlines conditions for outpatient psychotherapeutic care of persons with chronic somatic diseases and addresses central problems in the differential diagnosis of mental and somatic disorders as well as treatment indications when comorbidity is present. Selected examples for the diagnosis and treatment of patients with cardiovascular disorder and diabetes, respectively, illustrate these aspects.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Jan 2011
[Somatic-psychiatric comorbidity. Definition and basic concept].
Patients with a complex history of illness and multiple diseases are increasingly the rule rather than the exception. To describe these patients, the term comorbidity is frequently used. The present overview provides a definition and description of the construct comorbidity. ⋯ The description of comorbidity comprises definition of the term against the similar constructs multimorbidity, burden of illness, and patient complexity as well as a subcategorization of types of comorbidity. With regard to measuring comorbidity, possibilities of aggregating comorbidities into a single sum score are presented. Finally, specific aspects of somatic-psychiatric comorbidity are critically discussed.