Neue Wege in der Versorgung von Patienten mitfunktionellen Syndromen – Interdisziplinäre Gruppen­behandlung in der Hausarztpraxis: Eine qualitative Studie^[*]

 

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Zusammenfassung

Schnittstellenprobleme behindern die kooperative Versorgung funktioneller Syndrome. Die speziALL-Studie untersuchte eine störungsorientierte Gruppenintervention durch Psychosomatiker und Hausarzt in dessen Praxis. Mit der Frage ihrer konkreten Zusammenarbeit analysierte unsere qualitative Studie Freitextantworten zur gemeinsamen Gruppenleitung von allen 18 Interventionsärzten. Aus Hausarzt-Sicht sollten 20-min strukturierte Vor- und Nachbesprechungen alle Sitzungen begleiten. Funktion der Vorbesprechungen sei: Distanz zum Alltag gewinnen, sich auf die Gruppe und aufeinander einstimmen, die Sitzung inhaltlich vorbereiten. Funktion der Nachbesprechungen sei: Austausch, Reflextion der Sitzung, Planung der Weiterbehandlung. Dem Psychosomatiker wurden die Rollen Gruppenleiter und Experte zugeschrieben. Sich selbst sahen die Hausärzte als Bezugsperson des Patienten, Bindeglied zwischen den Ebenen und Kotherapeuten. Zentral erschien eine gelingende Rollenaufteilung.

Abstract

Interface problems between health care sectors hinder collaborative care in functional syndromes. The speciAL trial investigated a disorder-oriented group intervention conducted by the general practitioner (GP) and a psychosomatic specialist (PS) in the GP’s office. To evaluate the GP-PS cooperation, our qualitative study analysed free text statements about collaborative group leading of all 18 intervention GPs. In the GPs’ view, all sessions should structuredly be prepared and reviewed together for 20 min. Functions of the preparatory communication were gaining distance from daily business, attunement to the group and to each other, and preparing for the session topics. Functions of the communication after the sessions were professional exchange, reflection of the session and further treatment planning. The GPs saw the PS’s role as a group leader and expert, their own role as a reference person for the patient, a link between all dimensions and a cotherapist. Crucial seemed a succeeding role splitting.

^* Gabriele Kirsch ist gleichberechtigte Erstautorin.

• Literatur

• 1 Ansseau M, Dierick M, Buntinkx F et al. High prevalence of mental disorders in primary care. J Affect Disord 2004; 78: 49-55
  CrossrefPubMedGoogle Scholar
• 2 Roca M, Gili M, Garcia-Garcia M et al. Prevalence and comorbidity of common mental disorders in primary care. J Affect Disord 2009; 119: 52-58
  CrossrefPubMedGoogle Scholar
• 3 Kruse J, Herzog W. Zwischenbericht zum Gutachten zur ambulanten psychosomatischen/psychotherapeutischen Versorgung in der kassenärztlichen Versorgung in Deutschland – Formen der Versorgung und ihre Effizienz. www.thorwart-online.de/Gutachten%20Psychotherapie%20KBV-Zwischenbericht%2016.01.2012.pdf [Zugriff am 10.05.2012]
  PubMedGoogle Scholar
• 4 Creed F, Barsky A. A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 2004; 56: 391-408
  Google Scholar
• 5 Hausteiner-Wiehle C, Schaefert R, Sattel H et al. AWMF-Leitlinie zum Umgang mit Patienten mit nicht-spezifischen, funktionellen und somatoformen Körperbeschwerden. 2012 AWMF-Reg.-Nr. 051-001 www.awmf.org/leitlinien/detail/ll/051-001.html [Zugriff am 11.05.2012]
  PubMedGoogle Scholar
• 6 Hahn SR, Thompson KS, Wills TA et al. The difficult doctor-patient relationship: somatization, personality and psychopathology. J Clin Epidemiol 1994; 47: 647-657
  CrossrefPubMedGoogle Scholar
• 7 Reid S, Whooley D, Crayford T et al. Medically unexplained symptoms – GPs’ attitudes towards their cause and management. Fam Pract 2001; 18: 519-523
  CrossrefPubMedGoogle Scholar
• 8 Timmer B, Bleichhardt G, Rief W. Importance of psychotherapy motivation in patients with somatization syndrome. Psychother Res 2006; 16: 348-356
  CrossrefPubMedGoogle Scholar
• 9 Bundespsychotherapeutenkammer. BPtK-Studie zu Wartezeiten in der ambulanten Versorgung. 2001 www.bptk.de/publikationen/bptk-studie.html [Zugriff am 10.05.2012]
  PubMedGoogle Scholar
• 10 Clatney L, Macdonald H, Shah SM. Mental health care in the primary care setting: family physicians’ perspectives. Can Fam Physician 2008; 54: 884-889
  PubMedGoogle Scholar
• 11 Mykletun A, Knudsen AK, Tangen T et al. General practitioners’ opinions on how to improve treatment of mental disorders in primary health care. Interviews with one hundred Norwegian general practitioners. BMC Health Serv Res 2010; 10: 35
  CrossrefPubMedGoogle Scholar
• 12 Fredheim T, Danbolt LJ, Haavet OR et al. Collaboration between general practitioners and mental health care professionals: a qualitative study. Int J Ment Health Syst 2011; 5: 13
  CrossrefPubMedGoogle Scholar
• 13 Rockman P, Salach L, Gotlib D et al. Shared mental health care. Model for supporting and mentoring family physicians. Can Fam Physician 2004; 50: 397-402
  PubMedGoogle Scholar
• 14 England E, Lester H. Integrated mental health services in England: a policy paradox. Int J Integr Care 2005; 5: e24
  PubMedGoogle Scholar
• 15 Macfarlane D. Current state of collaborative mental health care. Mississauga, ON: Canadian Collaborative Mental Health Initiative; 2005. www.ccmhi.ca/en/products/documents/12_OverviewPaper_EN.pdf [Zugriff 10.05.2012]
  Google Scholar
• 16 Kelly BJ, Perkins DA, Fuller JD et al. Shared care in mental illness: A rapid review to inform implementation. Int J Ment Health Syst 2011; 5: 31
  CrossrefPubMedGoogle Scholar
• 17 Thota AB, Sipe TA, Byard GJ et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med 2012; 42: 525-538
  CrossrefPubMedGoogle Scholar
• 18 Roy-Byrne PP, Katon W, Cowley DS et al. A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care. Arch Gen Psychiatry 2001; 58: 869-876
  CrossrefPubMedGoogle Scholar
• 19 Dobscha SK, Corson K, Perrin NA et al. Collaborative care for chronic pain in primary care: a cluster randomized trial. JAMA 2009; 301: 1242-1252
  CrossrefPubMedGoogle Scholar
• 20 van der Feltz-Cornelis CM, van Oppen P, Ader HJ et al. Randomised controlled trial of a collaborative care model with psychiatric consultation for persistent medically unexplained symptoms in general practice. Psychother Psychosom 2006; 75: 282-289
  CrossrefPubMedGoogle Scholar
• 21 Fink P, Rosendal M. Recent developments in the understanding and management of functional somatic symptoms in primary care. Curr Opin Psychiatry 2008; 21: 182-188
  CrossrefPubMedGoogle Scholar
• 22 Henningsen P, Zipfel S, Herzog W. Management of functional somatic syndromes. Lancet 2007; 369: 946-955
  Google Scholar
• 23 Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med 2007; 69: 881-888
  CrossrefPubMedGoogle Scholar
• 24 Abbass A, Kisely S, Kroenke K. Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials. Psychother Psychosom 2009; 78: 265-274
  CrossrefPubMedGoogle Scholar
• 25 Kashner TM, Rost K, Cohen B et al. Enhancing the health of somatization disorder patients. Effectiveness of short-term group therapy. Psychosomatics 1995; 36: 462-470
  CrossrefPubMedGoogle Scholar
• 26 Tschuschke V, Weber R, Horn E et al. Ambulante psychodynamische Kurzgruppenpsychotherapie bei Patienten mit somatoformen Störungen. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 2007; 55: 87-95
  CrossrefPubMedGoogle Scholar
• 27 van Dulmen AM, Fennis JF, Bleijenberg G. Cognitive-behavioral group therapy for irritable bowel syndrome: effects and long-term follow-up. Psychosom Med 1996; 58: 508-514
  PubMedGoogle Scholar
• 28 Leibbrand R, Hiller W. Cognitive behavior therapy for functional gastrointestinal disorders: is group treatment effective?. Acta Neuropsychiatrica 2003; 15: 242-248
  CrossrefPubMedGoogle Scholar
• 29 Tkachuk GA, Graff LA, Martin GL et al. Randomized Controlled Trial of Cognitive-Behavioral Group Therapy for Irritable Bowel Syndrome in a Medical Setting. J Clin Psychol Med Settings 2003; 10: 57-69
  CrossrefPubMedGoogle Scholar
• 30 Potts SG, Lewin R, Fox KA et al. Group psychological treatment for chest pain with normal coronary arteries. QJM 1999; 92: 81-86
  CrossrefPubMedGoogle Scholar
• 31 Lidbeck J. Group therapy for somatization disorders in general practice: effectiveness of a short cognitive-behavioural treatment model. Acta Psychiatr Scand 1997; 96: 14-24
  PubMedGoogle Scholar
• 32 McLeod CC, Budd MA, McClelland DC. Treatment of somatization in primary care. Gen Hosp Psychiatry 1997; 19: 251-258
  CrossrefPubMedGoogle Scholar
• 33 Martin A, Rauh E, Fichter M et al. A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomized clinical trial. Psychosomatics 2007; 48: 294-303
  CrossrefPubMedGoogle Scholar
• 34 Rembold SME. Somatoforme Störungen in der Hausarztpraxis: Konstruktion und Evaluation eines psychosozialen Gruppenprogramms. Gruppenpsychother Gruppendynamik 2011; 47: 2-21
  PubMedGoogle Scholar
• 35 Lester H, Glasby J, Tylee A. Integrated primary mental health care: threat or opportunity in the new NHS?. Br J Gen Pract 2004; 54: 285-291
  PubMedGoogle Scholar
• 36 Craven M, Bland R. Better Practices in Collaborative Mental Health Care: An Analysis of the Evidence Base. Can J Psych 2006; 51 (Suppl. 01) May http://www.ccmhi.ca/en/products/documents/04_BestPractices_EN.pdf [Zugriff am 10.12.2011]
  PubMedGoogle Scholar
• 37 Schaefert R, Kaufmann C, Bölter R et al. Somatoforme Syndrome in der Hausarztpraxis. Manual zur interdisziplinären Gruppentherapie. Psychotherapeut 2011; 56: 315-324
  CrossrefPubMedGoogle Scholar
• 38 Schaefert R, Kaufmann C, Wild B et al. Specific Collaborative Group Intervention for Patients with Medically Unexplained Symptoms in General Practice: A Cluster Randomized Controlled Trial. Psychother Psychosom 2012; Resubmitted
  PubMedGoogle Scholar
• 39 Schaefert R, Benedikt G, Sauer N et al. FUNKTIONAL-Forschungsprojekt – Früherkennung und Behandlung funktioneller/somatoformer Beschwerden in der Allgemeinarztpraxis. Notfall und Hausarztmedizin 2005; 31: 580-589
  PubMedGoogle Scholar
• 40 Henningsen P, Hartkamp N, Loew T et al. Somatoforme Störungen. Leitlinien und Quellentexte. Schattauer 2002
  PubMedGoogle Scholar
• 41 Stuart S, Noyes Jr R. Interpersonal psychotherapy for somatizing patients. Psychother Psychosom 2006; 75: 209-219
  CrossrefPubMedGoogle Scholar
• 42 Sattel H, Lahmann C, Gündel H et al. Brief psychodynamic-interpersonal psychotherapy for patients with multisomatoform disorder: A randomised controlled trial. Br J Psychiatry 2012; 200: 60-67
  CrossrefPubMedGoogle Scholar
• 43 Buffington CA. Developmental influences on medically unexplained symptoms. Psychother Psychosom 2009; 78: 139-144
  CrossrefPubMedGoogle Scholar
• 44 Rudolf G. Strukturbezogene Psychotherapie. Leitfaden zur psychodynamischen Therapie struktureller Störungen. Stuttgart: Schattauer; 2006
  Google Scholar
• 45 Mattke D, Reddemann L, Strauß B. Keine Angst vor Gruppen! Gruppenpsychotherapie in Praxis und Forschung. Stuttgart: Klett-Cotta; 2009
  Google Scholar
• 46 Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002; 64: 258-266
  CrossrefPubMedGoogle Scholar
• 47 Fink P, Ewald H, Jensen J et al. Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization. J Psychosom Res 1999; 46: 261-273
  CrossrefPubMedGoogle Scholar
• 48 Christensen KS, Fink P, Toft T et al. A brief case-finding questionnaire for common mental disorders: the CMDQ. Fam Pract 2005; 22: 448-457
  CrossrefPubMedGoogle Scholar
• 49 Mayring P. Qualitative Inhaltsanalyse. Grundlagen und Techniken. Weinheim und Basel: Beltz; 2010
  Google Scholar
• 50 Barbour RS. Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?. BMJ 2001; 322: 1115-1117
  CrossrefPubMedGoogle Scholar
• 51 Steinke I. Gütekriterien qualitativer Forschung. In: Flick U, von Kardorff E, Steinke I. Hrsg Qualitative Forschung. Ein Handbuch. Reinbek bei Hamburg: Rowohlts Enzyklopädie. 2009: 319-331
  Google Scholar
• 52 Böttger E. Co-Leitung. In: Haubl R, Lamott F. Hrsg Handbuch Gruppenanalyse. München: Quintessenz; 1994: 118-128
  Google Scholar
• 53 Bostwick G. “Where’s Mary?”: A review of the group treatment dropout literature. Social Work with Groups 1987; 10: 117-131
  CrossrefPubMedGoogle Scholar
• 54 Mattke D. Nebenwirkungen psychodynamischer Gruppentherapie. Psychodynamische Psychotherapie 2008; 7: 67-78
  PubMedGoogle Scholar
• 55 Kisely S, Duerden D, Shaddick S et al. Collaboration between primary care and psychiatric services: does it help family physicians?. Can Fam Physician 2006; 52: 876-877
  PubMedGoogle Scholar
• 56 Bonauer N, Kley S, Viapiano M et al. Hrsg Kassenärztliche Vereinigung Baden-Württemberg, Qualitätsbericht 2005. Stuttgart: 2006: 101
  Google Scholar
• 57 Konnopka A, Schaefert R, Heinrich S et al. Economics of Medically Unexplained Symptoms: A Systematic Review of the Literature. Psychother Psychosom 2012; 81: 265-275
  CrossrefPubMedGoogle Scholar
• 58 Zepf S, Mengele U, Hartmann S. Zum Stand der ambulanten psychotherapeutischen Versorgung der Erwachsenen in der Bundesrepublik Deutschland. Psychother Psychosom Med Psychol 2003; 53: 152-162
  Article in Thieme ConnectPubMedGoogle Scholar
• 59 Gask L, Dowrick C, Salmon P et al. Reattribution reconsidered: narrative review and reflections on an educational intervention for medically unexplained symptoms in primary care settings. J Psychosom Res 2011; 71: 325-334
  CrossrefPubMedGoogle Scholar
• 60 van der Feltz-Cornelis CM, Hoedeman R, Keuter EJ et al. Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: disease management according to risk profiles. J Psychosom Res 2012; 72: 168-169
  CrossrefPubMedGoogle Scholar
• 61 Morriss R. Role of mental health professionals in the management of functional somatic symptoms in primary care. Br J Psychiatry 2012; 200: 444-445
  CrossrefPubMedGoogle Scholar