Vogel B, Jahed J, Bengel J, Barth J, Härter M, Baumeister H
Abteilung für Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, Freiburg.
Rehabilitation (Stuttg). 2009 Dec;48(6):361-8. doi: 10.1055/s-0029-1241810. Epub 2010 Jan 12.
A pilot study was conducted to implement and evaluate a routine gradual psycho-diagnostic programme to improve diagnostics and treatment of mental disorders in somatic rehabilitation centres. First of all, implementation strategies were acquired in trainings together with psychologists and physicians. The psycho-diagnostic programme consists of a screening instrument (PHQ-9) designed to permit time-effective detection of comorbid mental disorders. Besides evaluation of the training, the aim of the study was to analyze the extent to which it is possible to implement the routine gradual psycho-diagnostic programme in practice. Additionally, it was intended to identify beneficial and obstructive conditions for implementation.
The pilot study was conducted in two orthopaedic and one cardiological rehabilitation centre. The training was evaluated directly after its completion using a questionnaire. Three months after its implementation, the introduction of the psycho-diagnostic programme was evaluated using interviews with n=11 physicians and psychologists.
The training was rated positively by the participants . Implementation of the entire gradual psycho-diagnostic programme was possible in one centre and to some degree in the other two. Beneficial for implementation were a frank organisational climate, sufficient time resources, and physicians' biopsychosocial understanding of disease. A dismissive attitude towards psycho-diagnostics, little communication between staff members, little perceived advantage for one's own work and fear to stigmatise patients by psychiatric diagnoses were obstructive.
Essential for a successful implementation are sufficient time and personal resources, a motivation for change in staff and centre management, and a positive attitude regarding psycho-diagnostics in clinic staff. Furthermore, flexibility in implementation strategies and the opportunity to participate in the implementation process are important.
开展一项试点研究，以实施并评估一项常规渐进式心理诊断项目，该项目旨在改善躯体康复中心精神障碍的诊断和治疗。首先，通过与心理学家和医生共同参与培训来获取实施策略。该心理诊断项目包含一种筛查工具（患者健康问卷-9，PHQ-9），旨在高效检测共病精神障碍。除了对培训进行评估外，本研究的目的还在于分析在实际中实施常规渐进式心理诊断项目的可行程度。此外，旨在确定实施过程中的有利和阻碍条件。
该试点研究在两个骨科康复中心和一个心脏康复中心进行。培训结束后立即通过问卷调查对其进行评估。在项目实施三个月后，通过对11名医生和心理学家进行访谈，对心理诊断项目的引入情况进行评估。
参与者对培训给予了积极评价。整个渐进式心理诊断项目在一个中心得以完全实施，在另外两个中心部分实施。有利于实施的因素包括坦诚的组织氛围、充足的时间资源以及医生对疾病的生物心理社会理解。对心理诊断持轻视态度、工作人员之间沟通较少、认为对自身工作益处不大以及担心因精神科诊断给患者带来污名化等因素则构成阻碍。
成功实施该项目的关键在于有充足的时间和人力、工作人员和中心管理层有变革的动力以及临床工作人员对心理诊断持积极态度。此外，实施策略的灵活性以及参与实施过程的机会也很重要。
