Multimodale Therapie bei Kindern und Jugendlichen mit chronischen Erkrankungen am Beispiel von psychischen Störungen und Cystischer Fibrose

Abstract

The current thesis elucidates the state of the art of interdisciplinary teamwork and so called multimodal therapy for chronic conditions in children and adolescents. Specifically, it covers cystic fibrosis (CF) and mental health problems, conditions of high relevance for public health. First, two analyses of a) survey data of a nationwide representative German sample and b) claims data of a statutory health insurance fund present frequencies of children and adolescents with common mental health problems and CF. Survey analyses show results depending on statistical and clinical case definition strategies on the one hand and differences between parent- and self-report on the other hand. Estimates on the incidence of CF based on claims data analyses are in line with the existing literature. Second, two systematic guideline reviews synthesize recommendations on multimodal therapy for concerned children and adolescents and discuss the results against the background of social legislation in the statutory health care system. Results show defi-cits in statutory conditions for interdisciplinary teamwork in the outpatient health care setting, revealing a need for change in the general conditions for multimodal therapy. Third, a) a survey on the health care utilization in a sample of patients of a CF-centre indicates high rates of children and adolescents with CF who do not receive multimodal therapy despite of a below average health related quality of life and a clear need for treatment. b) A claims data analysis presents important insight into the current utilization patterns of children and adolescents with common mental health problems. Against guideline recommendations for later pharmacological treatment, age is hardly ever associated with drug prescription in the common mental health problems. Fourth, emphasizing the need of scientific pilot projects, an action plan is suggested to improve the structural and process quality of multimodal therapy. A theoretical concept illustrates the development of a database that provides more transparency in health care and enables the development of a care flat rate within a capitated payment system. Considering strength and limitations of different databases, this thesis indicates an explicit need for multimodal treatment that is inadequately met and discusses the gap between guideline recommendations and statutory conditions. Implications for better health care provision are specified in the end.