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Ulrich Michael Hemmeter Psychiatry Quality Committee And Geriatric Psychiatry Expert Group of ANQ

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PD Dr med Dr phil Ulrich Michael Hemmeter, Head of Psychiatric Services of Psychiatrie St.Gallen Nord, Member of the Board of the Swiss Society of Psychiatry and Psychotherapy for the Elderly (SGAP)

Ulrich Hemmeter, tell us what you do in connection with the ANQ committees? What do you find particularly interesting about your work?

Three years ago I was elected as the representative of Geriatric Psychiatry to the ANQ Psychiatry Quality Committee. Since 2020 I have also been working in the new ANQ Geriatric Psychiatry Expert Group. In this connection, I am especially interested in the question of how the quality of treatment in psychiatry and psychotherapy can be measured accurately. This is something I was already concerned with in the past. At the time, I was scientific advisor to the pilot project of the ANQ predecessor organisation, the KIQ, in which diagnosis-specific reviews were conducted. These reviews may have revealed the individual issues very clearly, but in practice they were difficult to undertake due to the heavy administrative workload. As a result, there were many dropouts during the measurements. The ANQ reviews that employ HoNOS and BSCL for diagnosis-independent third-party rating and self-rating of all patients are easier to conduct; consequently the data quality is also better.

You mentioned the new geriatric psychiatry expert group. What are the considerations that led to the formation of this body?

The treatment approaches for mental illness in the elderly overlap with the approaches employed for younger people, but in some cases they also differ significantly from those used in younger patients. Here I’m thinking specifically about delirium and the diseases frequently associated with it, and topics such as a decline in physical and mental capacity, fear of a loss of autonomy, loneliness and transfer to a nursing home. These issues play a major role in depression and anxiety disorders in the elderly, for example.

Modern assessment tools do not always meet the specific treatment requirements of geriatric psychiatry: there are many patients who are unable to complete a questionnaire like the BSCL checklist, or whose ability to do so is limited. The ANQ expert group is tasked with investigating this issue. We determine which elements are central to quality of care in geriatric psychiatry and how these elements could be measured pragmatically and without major additional administrative effort.

What do you feel is particularly important when analysing the review results?

The result of the outcome assessments cannot simply be equated with the overall quality of a medical institution. The ANQ reviews can only reflect partial aspects. I think it is vital that ANQ makes explicit reference to this point when the results are published. This distinction is also important when it comes to in-house analysis. Just because the review results exceed the anticipated value does not mean everything is perfect. And vice versa. Another key problem that I see is how the data is collected and recorded. The data provided by an institution must be accurate and complete if it is to serve as a primary and important indicator of quality.

«The data provided by an institution must be accurate and complete if it is to serve as a primary and important indicator of quality.»

2020 was dominated by the COVID-19 pandemic. To what extent did this change how you work?

The visitor ban and restrictions on movement had a huge impact on the in-patient sector. Freedom of movement was highly restricted for patients and the range of therapies available reduced. Nevertheless, we continued to need more personnel. In addition, there were staff absences, especially during the second wave. In the outpatient sector, we relied increasingly on online interventions.

There was less impact on the work of the ANQ committees. Some of their meetings were held online. This worked out well. Only the informal discussions in and around these meetings were affected, unfortunately.

In 2020, it was possible to publish the results for Forensic Psychiatry with transparency for the very first time. Will there be anything new to report soon?

Exactly, the values for Forensic Psychiatry were reported separately for the first time for a new and fourth type of clinical facility. There are currently plans to extend the assessments to the day clinic sector. In 2020, the ANQ Board approved a corresponding pilot project.

How should psychiatry reviews develop in future?

Looking ahead, the ANQ reviews should cover as many quality aspects of treatment and care as possible. However, for this to happen, the review process must not unduly burden the medical institutions involved. In my opinion, to achieve this, we should also make better use of the existing data. We also need to include additional indicators, for example the readmission rate for chronic illnesses and the number of patients it was possible to reintegrate into normal life or work.

The outcome assessments will never be able to completely capture treatment quality; however, they should depict as much as possible.

«The ANQ reviews should cover as many quality aspects of treatment and care as possible.»

Ulrich Michael Hemmeter is a Consultant Psychiatrist and Psychotherapist specialising in Consultation and Liaison Psychiatry, Geriatric Psychiatry and Geriatric Psychotherapy. He is also a certified sleep disorder specialist. After studying psychology and medicine in Giessen, he gained further postgraduate qualifications at the University Hospitals of Giessen, Freiburg, Basel and Marburg and at the Max Planck Institute of Psychiatry in Munich. He is now a Consultant in Geriatric psychiatry and Neuropsychiatry and a member of the executive board at St. Gallen Nord Psychiatric Hospital.

Photos: © Geri Krischker / ANQ