Ambulante Psychotherapie unter Routinebedingungen: Forschungsbefunde aus dem deutschsprachigen Raum

Abstract

There is a growing body of literature recognizing the importance of outpatient psychotherapy. Several studies investigated the efficacy of outpatient psychotherapy and aspects of the health care system under natural conditions. This paper gives an overview of studies from German speaking countries (TRANS-OP-, TK-, PAP-S- and QS-PSY-BAY-study).The results of the different studies indicate both, positive outcome of the therapies (e. g., reduction of symptoms with an average ES of 1,03; improvement of symptoms despite premature termination) as well as an economic benefit (end of treatment depending on treatment outcome and not limited by therapy sessions; extensions of psychotherapy only if patient is highly impaired and therapeutic alliance is positive; high reduction of supply costs and sick leave). However, the low health care density in rural areas and the waiting periods before starting therapy are indicators of structural problems of the health care system with respect to outpatient psychotherapy.The efficacy of outpatient psychotherapies under natural conditions is sufficiently supported. Future studies should investigate structural aspects of the health care system, for example by focussing on the establishment of inter-sectoral connections between different professional groups and a reduction of bureaucratic actions.

Psychotherapeutic Consultation Services in the Workplace: A Longitudinal Analysis of Treatments and Sick Leave Using Health Insurance Data

“…This difference was found when controlled for age and sex or when indicators of impairment were additionally included as covariates. The observed reduction in sick leave is generally consistent with the reported reduction after outpatient psychotherapy ( 54 , 57 ), inpatient psychosomatic rehabilitation in Germany ( 80 ), and other interventions that aim at reducing sickness absence ( 33 ). Regression analyses also showed significantly elevated sick-leave days across time for participants who received a recommendation for inpatient treatment (compared with PSIW sufficient) and for participants who had previously seen a mental health specialist or other practitioner due to mental health issues (compared with no previous contacts).…”

“…Despite the aforementioned limitations, this study has several strengths. First, the continuous observation with data from a total of 3 years can be considered a strength, as standard pre–post studies under naturalistic conditions often exclude time periods during treatment ( 54 – 57 ). Second, the available data quality can be considered high as it is not biased by recall, motivation, or impairment of the participants ( 49 , 50 ).…”

“…As treatment paths of PSIW participants are very heterogeneous and subject of our interest, we wanted to obtain a continuous observation of treatments and sick leave as measured in days. On the basis of clinical experience and results of studies on outpatient psychotherapy in Germany ( 53 , 57 – 59 ), we assumed that in the first year after PSIW treatments (and symptom reduction) were still ongoing for a substantial proportion of participants. Thus, we expected a reduction in sick leave in the second year as compared with the pre-PSIW observation period.…”

Beurteilung und Nutzung der 2016 reformierten Psychotherapierichtlinie

“…Dadurch ist es für Patienten schwierig, einen Psychotherapieplatz in ländlichen Regionen oder in weniger attraktiven Städten zu bekommen [2]. Auch Altman et al weisen in ihrer Übersichtsarbeit darauf hin, dass die geringe Versorgungsdichte auf dem Land sowie lange Wartezeiten auf Therapieplätze ein strukturelles Problem der ambulanten Psychotherapie darstellen, welches in zukünftigen Studien fokussiert werden sollte [3].…”

Differentielle Indikation in der Versorgung von Patienten mit psychischen Störungen

“…In zahlreichen Studien haben sich die genannten Behandlungs optionen als wirksam erwiesen. Breit angelegte Untersuchungen und Metaanalysen zeigen, dass Psychotherapie auch unter natura listischen Bedingungen mit großer Effektstärke wirksam ist [4][5][6][7][8] und damit einen großen volkswirtschaftlichen Nutzen aufweist [4,[9][10][11]. Psychotherapie wird gegenüber pharmakologischen Be handlungen von den Patienten präferiert und seltener abgebro chen [12].…”