gms | German Medical Science

Background: Patients with mental and behavioural disorders in outpatient treatment have a considerable prevalence of more than 33% in outpatient treatment in the considered region with a large range involved areas e.g. of incapacity for work and limited corporate participation.

Materials and methods: We use outpatient drug prescription and diagnostic data of the Statutory Health Insurance in Schleswig-Holstein. Diagnostic data have a quarterly resolution, for prescription data the exact day is known. Therefore a joint analysis can only be done quarterly. We use the second quarter of 2018 with 1.7 million patients with diagnostic data and 1.4 million patients with drug prescriptions. We use the ICD-10 system (International Statistical Classification of Diseases and Related Health Problems 10th Revision), wherein patients with mental and behavioural disorders have a code with a leading F digit. For drug classification we apply the international ATC system (Anatomic Therapeutic Chemical system with German specifications provided by the German Institute of Medical Documentation and Information (DIMDI). For calculations we have used the script language gawk and Mathematica by Wolfram Research. The considerations are patient centered. That means that all diagnoses and all drug of all physicians a patient has visited in the quarter analyzed are considered together.

Results: 33.3% of all patients have an F-diagnosis (mental and behavioural disorders), documented by at least one physician; these are 34.9% of the patients with drug prescriptions. Those patients have 12.9 diagnoses on three-digit ICD level and 12.9 drug groups on the ATC four-digit level. Multimorbidity and polypharmacy are related, the R² has a value of 0.53. The three-dimensional representation of case numbers in dependence of the number of diagnoses and the number of drug groups gives a better insight. The five leading drug groups in relation to the F-diagnoses are N06A (antidepressants), N02A (opioids), N05A (antipsychotrics), N03A (antielileptics) and N02B (other analgetics and antipyretics) with decreasing case numbers. The top drug groups for comorbidities not directly related to the spectrum of F-diagnoses are B01A (antitrombotic agents), R03A (adrenergics, inhalants), A02B (drugs for peptic ulcer and gastro-oesophageal reflux diseases, GORD), A10A (insulins and analogues) and A10B (blood glucose lowering drugs, excl. insulins) again with decreasing case numbers. On average the patients with F-diagnoses have visited 2.4 physicians with one as the modal value. On a two-digit level the top case numbers occur for F4 (neurotic, stress-related and somatoform disorders, 69.0% women), F3 (mood affective disorders, 69.2% women) and F1 (mental and behavioural disorders due to psychoactive substance use, 46.4% women). On three-digit level we find F32 (depressive episode, 69.5% women), F45 (somatoform disorders, 70.3% women) and F17 (mental and behavioural disorders due to use of tobacco, 49.3% women).

Conclusion: The large prevalence of patients with mental and behavioural disorders shows the need for coordinated treatment strategies and preventive measures. The cooperation of general practitioners and specialists should be further promoted. Age, sex and diagnose-related areas of focus will play a key role.

Abbildung 1 [Fig. 1]