Access to outpatient psychotherapy and utilisation of services after structural reform in Germany: analysis of administrative claims data for people with depression

Background Early initiation of therapy can be crucial for the course of mental health problems. Among other new care elements, the structural reform of the outpatient psychotherapy system in Germany introduced psychotherapeutic consultations to enable early low-threshold access to psychotherapists. This study aims to compare access to outpatient psychotherapeutic care for patients diagnosed with a first-time diagnosis of depression before and after the reform, and to analyse the utilisation of other relevant health services. Methods A retrospective cohort-based analysis was conducted using anonymised administrative claims data to examine the initial contact to the outpatient psychotherapeutic system for children and adolescents (under 18 years old) and adults (over 21 years old) with a first-time diagnosis of depression. Patients with at least one documented ICD-10 depression diagnosis in either the first quarter of 2016 (pre-reform) or the first quarter of 2018 (post-reform), and at least one further diagnosis within 12 months, were included in the analysis. The initial contact to outpatient psychotherapeutic care, as well as the utilisation of other relevant health care services (i.e. inpatient stay, antidepressant prescriptions, low-intensity interventions) was analysed for patients with and without initial contact. Descriptive and logistic regression analyses were performed. Results A total of 11,038 children and adolescents and 284,773 adults were included in the analysis. The proportion of children and adolescents and adults who had initial contact with outpatient psychotherapeutic care increased by 14 and 5 percentage points respectively between the pre- and post-reform period [both: p < 0,001]. The main effect parameters for initial contact were age, sex and the severity of depression diagnosis. The analysis revealed that, in terms of health care utilisation, patients who had an initial contact had significantly more relevant health care services such as antidepressant prescriptions or low-intensity interventions after initial contact in the post-reform period than in the pre-reform period. Those who had no initial contact used other relevant health care services less frequently in the post-reform period. Conclusions This analysis indicates that the outpatient psychotherapy system became more accessible for people with a first-time diagnosis of depression in terms of initial contact to psychotherapists following the reform and sheds light on the complexities of care provision for those with depression.