Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
PLoS One. 2020 Feb 5;15(2):e0228748. doi: 10.1371/journal.pone.0228748. eCollection 2020.
Stepped and collaborative care with outpatient psychotherapy as one treatment step is guideline-recommended for mental health care. To date, the experiences and evaluation of psychotherapists regarding collaboration and stepped care have been neglected. In order to improve collaborative mental health care, this qualitative study aimed at identifying psychotherapists' perspectives and needs within collaboration and stepped care.
Semi-structured qualitative interviews with 20 German outpatient psychotherapists were conducted and analyzed applying thematic analysis. The analysis was realized in a recursive process to first identify themes and then relate these themes back to the research questions with regard to collaboration and stepped care.
Collaboration mainly took place in small networks, with general practitioners and psychiatrists as the most important partners and psychotherapists wishing to intensify collaboration. Main barriers for collaboration were seen in deficient resources and remuneration and in a perceived lack of esteem by other medical specialties. Stepped care was appreciated for intensified collaboration and low-threshold access to care. Doubts were cast on its implementation within current health care conditions, worries concerned a primacy of economic principles instead of patient-orientation. Among further needs, psychotherapists demanded increased knowledge about psychotherapy, especially among general practitioners.
Psychotherapists expressed ambivalent attitudes towards stepped and collaborative care, substantially influenced by health care conditions and the perceived own standing among care providers. Psychotherapists' needs within stepped care comprise intensified collaboration, sufficient time, personal and financial resources for collaboration and opportunities for a constructive interprofessional dialogue.
阶梯式和协作式护理，结合门诊心理治疗作为一个治疗步骤，是精神卫生保健的指南推荐。迄今为止，心理治疗师在协作和阶梯式护理方面的经验和评估一直被忽视。为了改善协作性的精神卫生保健，本定性研究旨在确定心理治疗师在协作和阶梯式护理方面的观点和需求。
对 20 名德国门诊心理治疗师进行了半结构化的定性访谈，并应用主题分析进行了分析。分析是在一个递归过程中进行的，首先确定主题，然后将这些主题与关于协作和阶梯式护理的研究问题联系起来。
协作主要发生在小网络中，全科医生和精神科医生是最重要的合作伙伴，心理治疗师希望加强协作。协作的主要障碍是资源和薪酬不足，以及其他医学专业对其缺乏尊重。阶梯式护理因其加强协作和低门槛获得护理而受到赞赏。对其在当前医疗保健条件下的实施存在疑虑，担忧是经济原则优先于以患者为中心的原则。进一步的需求包括，心理治疗师要求增加对心理治疗的了解，特别是在全科医生中。
心理治疗师对阶梯式和协作式护理持矛盾态度，这主要受到医疗保健条件和治疗师在医疗服务提供者中的地位的影响。心理治疗师在阶梯式护理方面的需求包括加强协作、有足够的时间、合作的个人和财务资源以及进行建设性的跨专业对话的机会。
