Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany; Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany; aQua - Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany; Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany; Department of Medicine and Health Services Research, BARMER Institute for Health System Research, Wuppertal, Germany; Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
Dtsch Arztebl Int. 2024 May 17;121(10):315-322. doi: 10.3238/arztebl.m2024.0039.
A structural reform of the German psychotherapy guideline in 2017 was intended to facilitate access to outpatient guideline psychotherapy. In the present study, we evaluate the effects of this reform in particular for patients with a comorbidity of mental disorders and chronic physical conditions (cMP).
Pre-post analyses of the two primary endpoints "percentage of mentally ill persons who have made an initial contact with a psychotherapist" and "waiting time for guideline psychotherapy" were carried out employing population-based and weighted routine statutory health insurance data from the German BARMER. The secondary endpoints included evaluations from the patients' perspective, based on a representative survey of patients in psychotherapy, and an overview of the health care situation based on data from the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) (study registration number: DRKS00020344).
From 2015 to 2018, the percentage of mentally ill persons who had made an initial contact with a psychotherapist rose moderately, from 3.7% (95% confidence interval, [3.6; 3.7]) to 3.9% [3.8; 3.9] among persons with cMP and from 7.3% [7.2; 7.4] to 7.6% [7.5; 7.7] among those with mental disorders but without any chronic physical condition (MnoP). The new structural elements were integrated into patient care. The interval of time between the initial contact and the beginning of guideline psychotherapy became longer in both groups, from a mean of 80.6 [79.4; 81.8] to 114.8 [113.4; 116.2] days among persons with complex disease and from 80.2 [79.2; 81.3] to 109.6 [108.4; 111.0] days among persons with non-complex disease; most patients considered the waiting time. Approximately 8% of the patients who sought psychotherapy reported that they had not obtained access to a psychotherapist.
Neither in general nor for patients with cMP did the introduction of the structural reform appreciably lower the access barriers to psychotherapy. Further steps are needed so that outpatient care can meet the needs of all patients and particularly those with cMP.
2017 年德国心理治疗指南进行了结构性改革，旨在为门诊指南心理治疗提供便利。本研究特别评估了这一改革对患有精神障碍和慢性躯体疾病（cMP）共病患者的影响。
利用德国 BARMER 的基于人群的加权常规法定健康保险数据，对两个主要结局指标“接受过初始心理咨询的精神障碍患者比例”和“指南心理治疗的等待时间”进行了治疗前后分析。次要结局指标包括来自接受心理治疗患者的患者视角评估，基于对接受心理治疗患者的代表性调查，以及基于德国法定医疗保险医师协会（Kassenärztliche Bundesvereinigung，KBV）数据的医疗保健情况概述（研究注册编号：DRKS00020344）。
2015 年至 2018 年，接受过初始心理咨询的精神障碍患者比例适度增加，cMP 患者从 3.7%（95%置信区间，[3.6；3.7]）增加至 3.9%[3.8；3.9]，非 cMP 患者从 7.3%[7.2；7.4]增加至 7.6%[7.5；7.7]。新的结构要素已融入患者护理中。两组的初始接触与指南心理治疗开始之间的时间间隔均延长，复杂疾病患者从 80.6[79.4；81.8]增加至 114.8[113.4；116.2]天，非复杂疾病患者从 80.2[79.2；81.3]增加至 109.6[108.4；111.0]天；大多数患者认为等待时间是合理的。大约 8%寻求心理治疗的患者报告说他们无法获得心理治疗师的帮助。
无论总体而言还是对于患有 cMP 的患者，结构性改革都没有明显降低心理治疗的准入障碍。需要采取进一步措施，以便门诊护理能够满足所有患者的需求，特别是那些患有 cMP 的患者的需求。
