Zugang und Inanspruchnahme psychosomatischer Versorgung aus ärztlicher Sicht: Eine qualitative Interviewstudie

 

 Buy Article Permissions and Reprints

Zusammenfassung

Hintergrund Chronisch entzündliche Hauterkrankungen sind häufig mit psychosozialen Beeinträchtigungen und einer reduzierten Lebensqualität vergesellschaftet. Ziel dieser Studie war es zu erfassen, wie spezialisiertes medizinisches Personal eines universitären Haut-Entzündungszentrums die Zugangswege und die Inanspruchnahme psychosomatischer Sondierungsgespräche oder Kurzzeitinterventionen bei PatientInnen mit chronisch entzündlichen Hauterkrankungen wahrnimmt.

Methoden Es wurden qualitative Erhebungen in Form von 10 Einzelinterviews mit medizinischem Personal durchgeführt, das zum Zeitpunkt der Befragung im Zentrum für entzündliche Hauterkrankungen der Uni-Hautklinik tätig war. Die Daten wurden inhaltsanalytisch mithilfe einer qualitativen Analysesoftware ausgewertet.

Ergebnisse Die Ergebnisse aus den geführten Einzelinterviews ergaben, dass die Einbindung einer psychosomatischen Versorgung innerhalb eines dermatologischen Entzündungszentrums vom ärztlichen Personal als durchweg positiv bewertet wurde. Die Option auf ein zeit- und zentrumsnahes Gesprächsangebot nimmt dabei eine besondere Rolle ein. Experten fühlen sich mit der ortsnahen Einbindung psychosomatischer Expertise sicherer im Umgang mit belasteten Patient*innen. Der holistische Ansatz scheint einen positiven Einfluss auf die individuelle Behandlung und die Beziehungsgestaltung mit den Patient*innen zu nehmen. Dabei zeigten sich keine wesentlichen Unterschiede im Geschlecht und über verschiedene Altersgruppen hinweg.

Diskussion Die Möglichkeit zur zentrumsnahen Anbindung von belasteten Patient*innen in Form von zusätzlichen psychosomatischen Sondierungsgesprächen wie auch dem Einsatz von adaptierten Kurzzeitinterventionen trägt zur holistischen Behandlung bei, scheint einen günstigen Einfluss auf den somatischen Behandlungsverlauf zu nehmen und unterstützt Ärzt*innen in ihrer Behandlung.

Abstract

Background Chronic inflammatory skin diseases reduce health-related quality of life of affected patients. The aim of this study was to evaluate the perception of specialized medical practitioners within a university based dermatological inflammation centre on accessibility and utilization of exploratory psychological consultations for patients with chronic inflammatory skin diseases.

Methods 10 qualitative surveys were conducted in the form of individual interviews with specialized medical practitioners at the center for inflammatory skin diseases university hospital Kiel. The interviews were evaluated by content analysis using qualitative software.

Results The qualitative survey showed that the integration of psychosomatic care within a dermatological inflammation centre was evaluated as consistently positive by all physicians. The possibility of a timely consultation within the same localization was of special interest. Experts feel safer in treating burdened patients when psychosomatic expertise was integrated in daily routines. The holistic approach seems to have a positive influence on individual treatment and the shaping of relationships with patients. There were no significant differences in gender and across different age groups.

Discussion Access to on-site psychosomatic expertise in form of additional psychosomatic exploratory consultations as well as the use of adapted short-term interventions contributes to a holistic treatment approach, seems to have a positive influence on the somatic treatment course and supports physician in their treatment.

Publication History

Article published online:
14 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• Literatur

• 1 Gupta MA, Gupta AK. A practical approach to the assessment of psychosocial and psychiatric comorbidity in the dermatology patient. Clin Dermatol 2013; 31: 57-61 DOI: 10.1016/j.clindermatol.2011.11.007.
  CrossrefPubMedGoogle Scholar
• 2 Koo J, Marangell LB, Nakamura M. et al. Depression and suicidality in psoriasis: review of the literature including the cytokine theory of depression. J Eur Acad Dermatol Venereol 2017; 31: 1999-2009 DOI: 10.1111/jdv.14460.
  CrossrefPubMedGoogle Scholar
• 3 Patel KR, Immaneni S, Singam V. et al. Association between atopic dermatitis, depression, and suicidal ideation: A systematic review and meta-analysis. J Am Acad Dermatol 2019; 80: 402-410 DOI: 10.1016/j.jaad.2018.08.063.
  CrossrefPubMedGoogle Scholar
• 4 Takeshita J, Grewal S, Langan SM. et al. Psoriasis and comorbid diseases: Epidemiology. J Am Acad Dermatol 2017; 76: 377-390 DOI: 10.1016/j.jaad.2016.07.064.
  CrossrefPubMedGoogle Scholar
• 5 Kage P, Simon JC, Treudler R. Atopic dermatitis and psychosocial comorbidities. J Dtsch Dermatol Ges 2020; 18: 93-102 DOI: 10.1111/ddg.14029.
  CrossrefPubMedGoogle Scholar
• 6 Dalgard FJ, Gieler U, Tomas-Aragones L. et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol 2015; 135: 984-991 DOI: 10.1038/jid.2014.530.
  CrossrefPubMedGoogle Scholar
• 7 Kurd SK, Troxel AB, Crits-Christoph P. et al. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol 2010; 146: 891-895 DOI: 10.1001/archdermatol.2010.186.
  CrossrefPubMedGoogle Scholar
• 8 van de Kerkhof PC, Reich K, Kavanaugh A. et al. Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis survey. J Eur Acad Dermatol Venereol 2015; 29: 2002-2010 DOI: 10.1111/jdv.13150.
  CrossrefPubMedGoogle Scholar
• 9 Elewski B, Alexis AF, Lebwohl M. et al. Itch: an under-recognized problem in psoriasis. J Eur Acad Dermatol Venereol 2019; 33: 1465-1476 DOI: 10.1111/jdv.15450.
  CrossrefPubMedGoogle Scholar
• 10 Hrehorow E, Salomon J, Matusiak L. et al. Patients with psoriasis feel stigmatized. Acta Derm Venereol 2012; 92: 67-72 DOI: 10.2340/00015555-1193.
  CrossrefPubMedGoogle Scholar
• 11 Pompili M, Bonanni L, Gualtieri F. et al. Suicidal risks with psoriasis and atopic dermatitis: Systematic review and meta-analysis. J Psychosom Res 2021; 141: 110347 DOI: 10.1016/j.jpsychores.2020.110347.
  CrossrefPubMedGoogle Scholar
• 12 Ronnstad ATM, Halling-Overgaard AS, Hamann CR. et al. Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: A systematic review and meta-analysis. J Am Acad Dermatol 2018; 79: 448-456 e430. DOI: 10.1016/j.jaad.2018.03.017.
  CrossrefPubMedGoogle Scholar
• 13 Liang SE, Cohen JM, Ho RS. Psoriasis and suicidality: A review of the literature. Dermatol Ther 2019; 32: e12771 DOI: 10.1111/dth.12771.
  CrossrefPubMedGoogle Scholar
• 14 Pronizius E, Voracek M. Dermatologistsʼ perceptions of suicidality in dermatological practice: a survey of prevalence estimates and attitudes in Austria. BMC Dermatol 2020; 20: 10 DOI: 10.1186/s12895-020-00107-w.
  CrossrefPubMedGoogle Scholar
• 15 Xiao Y, Zhang X, Luo D. et al. The efficacy of psychological interventions on psoriasis treatment: a systematic review and meta-analysis of randomized controlled trials. Psychol Res Behav Manag 2019; 12: 97-106 DOI: 10.2147/PRBM.S195181.
  CrossrefPubMedGoogle Scholar
• 16 Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) – a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210-216 DOI: 10.1111/j.1365-2230.1994.tb01167.x.
  CrossrefPubMedGoogle Scholar
• 17 von Spreckelsen R, Mrowietz U, Emmert H. Intensive short-term schema therapy intervention in a patient with psoriasis – case report and clinical management. Journal der Deutschen Dermatologischen Gesellschaft 2020; 18 DOI: 10.1111/ddg.14167.
  CrossrefPubMedGoogle Scholar
• 18 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19: 349-357 DOI: 10.1093/intqhc/mzm042.
  Google Scholar
• 19 Dicicco-Bloom B, Crabtree BF. The qualitative research interview. Med Educ 2006; 40: 314-321 DOI: 10.1111/j.1365-2929.2006.02418.x.
  CrossrefPubMedGoogle Scholar
• 20 Mayring P. Einführung in die qualitative Sozialforschung. Weinheim, Basel: Beltz Verlag; 2016
  Google Scholar
• 21 King N, Horrocks C, Brooks J. Interviews in Quality Research. London: SAGE Publications Ltd (Los Angeles, London, New Delhi, Singapore, Washington DC, Melbourne); 2019
  Google Scholar
• 22 Kuckartz U, Rädiker S. Qualitative Inhaltsanalyse. Methoden, Praxis, Computerunterstützung. Weinheim, Basel: Beltz Juventa; 2018
  Google Scholar
• 23 Fortune DG, Richards HL, Kirby B. et al. A cognitive-behavioural symptom management programme as an adjunct in psoriasis therapy. Br J Dermatol 2002; 146: 458-465 DOI: 10.1046/j.1365-2133.2002.04622.x.
  CrossrefPubMedGoogle Scholar
• 24 Qureshi AA, Awosika O, Baruffi F. et al. Psychological Therapies in Management of Psoriatic Skin Disease: A Systematic Review. Am J Clin Dermatol 2019; 20: 607-624 DOI: 10.1007/s40257-019-00437-7.
  CrossrefPubMedGoogle Scholar
• 25 Singh SM, Narang T, Vinay K. et al. Clinic-based Group Multi-professional Education Causes Significant Decline in Psoriasis Severity: A Randomized Open Label Pilot Study. Indian Dermatol Online J 2017; 8: 454-459 DOI: 10.4103/idoj.IDOJ_68_17.
  CrossrefPubMedGoogle Scholar
• 26 Adler RH. Engelʼs biopsychosocial model is still relevant today. J Psychosom Res 2009; 67: 607-611 DOI: 10.1016/j.jpsychores.2009.08.008.
  CrossrefPubMedGoogle Scholar
• 27 Lakuta P, Przybyla-Basista H. Toward a better understanding of social anxiety and depression in psoriasis patients: The role of determinants, mediators, and moderators. J Psychosom Res 2017; 94: 32-38 DOI: 10.1016/j.jpsychores.2017.01.007.
  CrossrefPubMedGoogle Scholar
• 28 Sommer R, Augustin M, Mrowietz U. et al. Perception of stigmatization in people with psoriasis-qualitative analysis from the perspective of patients, relatives and healthcare professionals. Hautarzt 2019; 70: 520-526 DOI: 10.1007/s00105-019-4411-y.
  CrossrefPubMedGoogle Scholar
• 29 Kroenke K, Spitzer RL, Williams JB. et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 2010; 32: 345-359 DOI: 10.1016/j.genhosppsych.2010.03.006.
  CrossrefPubMedGoogle Scholar
• 30 Khan F, Amatya B, Ng L. et al. Multidisciplinary rehabilitation after primary brain tumour treatment. Cochrane Database Syst Rev 2015; CD009509 DOI: 10.1002/14651858.CD009509.pub3.
  CrossrefPubMedGoogle Scholar
• 31 Hofer M. Advanced chronic lung disease: need for an active interdisciplinary approach. Swiss Med Wkly 2007; 137: 593-601
  PubMedGoogle Scholar
• 32 Tremblay D, Roberge D, Touati N. et al. Effects of interdisciplinary teamwork on patient-reported experience of cancer care. BMC Health Serv Res 2017; 17: 218 DOI: 10.1186/s12913-017-2166-7.
  CrossrefPubMedGoogle Scholar
• 33 Hennink MM, Kaiser BN, Marconi VC. Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough?. Qual Health Res 2017; 27: 591-608 DOI: 10.1177/1049732316665344.
  CrossrefPubMedGoogle Scholar