Fritzsche K, Sandholzer H, Werner J, Brucks U, Cierpka M, Deter H C, Härter M, Höger C, Richter R, Schmidt B, Wirsching M
Abt. für Psychosomatik u. Psychotherapeutische Medizin, Universitätsklinik für Psychiatrie u. Psychosomatik, Freiburg.
Psychother Psychosom Med Psychol. 2000 Jun;50(6):240-6. doi: 10.1055/s-2000-13252.
Since 1987, psychosocial primary care (PPC) provided by General Practitioners, are reimbursed by German health insurances. The aim of the psychosocial primary care is to improve recognition and treatment of mental disorders in the primary care sector. As a part of a eight-center national demonstration program on quality management in the outpatient services, General Practitioners (n = 191) from 5 regions participated in the study. 1341 treatment episodes of patients with predominately psychosocial strain were documented. Differences between psychosocial strain, treatment and outcome were determined by analyses of variance. Men and patients beyond the age of 65 were underrepresented. Psychosocial treatments were offered more often to those patients, who had the highest level of anxiety and depression. Patients with physical illness, with pain and without psychological attribution to the illness belief were offered less psychosocial interventions and reached a worse outcome. The study outcome helps to improve training programs as to recognition and treatment of psychosocial problems in primary care. Male and generally elderly patients with somatic symptoms and lack of psychological attribution need a special psychosocial intervention to improve the outcome.
自1987年以来，德国医疗保险对全科医生提供的心理社会初级保健（PPC）进行报销。心理社会初级保健的目的是提高初级保健部门对精神障碍的识别和治疗水平。作为门诊服务质量管理全国性八中心示范项目的一部分，来自5个地区的191名全科医生参与了该研究。记录了1341例主要存在心理社会压力的患者的治疗过程。通过方差分析确定心理社会压力、治疗和结果之间的差异。男性和65岁以上的患者代表性不足。心理社会治疗更多地提供给焦虑和抑郁程度最高的患者。患有躯体疾病、疼痛且疾病认知中无心理因素的患者接受的心理社会干预较少，且治疗效果较差。该研究结果有助于改进初级保健中识别和治疗心理社会问题的培训项目。有躯体症状且缺乏心理因素、男性以及一般老年患者需要特殊的心理社会干预以改善治疗效果。
