Psychotherapists' perspectives on collaboration and stepped care in outpatient psychotherapy-A qualitative study.
Ontology highlight
ABSTRACT:
SUBMITTER: Maehder K
PROVIDER: S-EPMC7002019 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundThere is growing evidence in the literature on the use of positive mental health (PMH) interventions among clinical samples. This qualitative study aims to explore the definitions of PMH from psychotherapists' perspectives, and to examine views and attitudes related to the construct.MethodsFocus group discussions were conducted with psychotherapists at a tertiary psychiatric institute. Focus group sessions were transcribed verbatim and transcripts were analyzed using an inductive thematic approach.ResultsFive themes related to psychotherapists' definition of PMH were identified: (1) acceptance; (2) normal functioning and thriving in life; (3) resilience; (4) positive overall evaluation of life; (5) absence of negative emotions and presence of positive emotion states. Themes related to views and attitudes towards PMH were: (1) novel and valuable for psychotherapy; (2) reservations with terminology; (3) factors influencing PMH.ConclusionPMH in psychotherapy is a multidimensional concept that means more than symptom management and distress reduction in clients. There is potential value for its application in psychotherapy practice, though some concerns need to be addressed before it can be well integrated.
| S-EPMC9055746 | biostudies-literature
Project description:BackgroundMany patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists' acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation.ObjectiveThe aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany.MethodsWe conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors.ResultsAgainst the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%), and reimbursement conditions (7/11, 67%), as key drivers for the acceptance and adoption of the model.ConclusionsWhile mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients' and therapists' engagement.Trial registrationGerman Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one.
| S-EPMC7333073 | biostudies-literature
Project description:BackgroundAccess to outpatient mental healthcare can be challenging for patients. In Germany, a national structural reform was implemented in 2017 to accelerate and enhance access to outpatient psychotherapy and reduce waiting times. During the first phase of the study 'Evaluation of a structural reform of the outpatient psychotherapy guideline (ES-RiP)' and embedded into a process evaluation, the implementation was to be evaluated through assessing general practitioners' (GPs) and psychotherapists' (PTs) perspectives regarding utilization of provided new measures, and perceived potential for optimization. Particular focus was on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs).MethodsThis exploratory cross-sectional qualitative study used on-site and online focus group discussions and semi-structured telephone interviews with GPs and outpatient PTs. Generated data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze participant characteristics collected via a socio-demographic questionnaire.ResultsPerspectives on the structural reform were heterogenous. GPs and PTs considered the component of timely initial psychotherapeutic assessment consultations beneficial. GPs disapproved of their deficits in detailed information about the structural reform and exchange with outpatient PTs. Improvement suggestions included structured short information exchange and joint quality circles. The overall number of available outpatient PTs in rural areas was perceived as insufficient. For patients with cMPs, GPs saw patient barriers for therapy access and continuity in low intrinsic motivation, physical impediments and older age. PTs also saw patient challenges regarding low intrinsic motivation and keeping scheduled appointments. They considered post-reform administrative efforts to be high and reported that the regulations (conformity) lead to planning difficulties and financial losses. Reform elements were tailored to fit in with PTs key therapy areas. Stronger networking and joint lectures were suggested as remedy for the currently still limited exchange with GPs. Unlike the GPs, PTs emphasized that accepting patients into psychotherapeutic treatment was independent of a possibly present chronic physical disease.ConclusionsThe findings contribute to understanding the integration of the delivered structural reform into daily care processes and provide an indication about reached targets and potential improvements. Further phases of the ES-RiP study can build on the findings and broaden insights.Trial registrationRegistration-ID DRKS00020344 (DRKS German Register of Clinical Trials.
| S-EPMC8570230 | biostudies-literature
Project description:This study explores elite athletes' experiences of psychotherapy administered by Swedish licensed psychologists or psychotherapists with and without specialisation in elite sports, addressing the research question: What do elite athletes experience as important for psychotherapy effectiveness when seeking treatment from a licensed clinical psychologist or psychotherapist? Five elite athletes (self-assigned women=4, self-assigned men=1; age range: 20-34 years) from three sports (fencing: n=2, handball: n=2, triathlon: n=1) volunteered to participate in interviews. All athletes had worked with more than one licensed psychologists/psychotherapist, either through a regional healthcare or an elite sports specialised clinic while being national or international elite sports level athletes. Data were inductively analysed by the use of reflexive thematic analysis. Trust and professionalism to the psychologist/psychotherapist were generated as an overarching theme. Themes created during data analysis included the psychologist/psychotherapist's (a) understanding of elite sports and of both the person and the athlete, (b) psychotherapeutic behaviours or skills (ie, holistic problem assessment, communication, empathy, validation, confidentiality, therapeutic alliance, goal-oriented content and ability to tailor psychotherapy to the athlete) and (c) conditions for psychotherapy (time, accessibility and appropriate support). Participants expressed difficulties in differentiating between qualified and unqualified mental health support providers. Mental health services originating within the sport context were perceived to improve accessibility and the possibility of regular sessions. Mental health services provided outside the immediate sporting context, with the psychologist/psychotherapist not being overly involved in sports, was however perceived to enable a more objective and holistic assessment of both non-sport and sport-related concerns impacting on athlete mental health. We conclude that sports organisations must facilitate athletes' access to psychological treatment, and additionally ensure that practitioners working with psychotherapy have professional expertise and are appropriately qualified. Sports organisations should also systematically evaluate mental health services to ensure quality and that they are up to date with best practices.
| S-EPMC11331869 | biostudies-literature
Project description:BackgroundAn electronic handover system provides a potential way to bridge the interface between psychotherapy and occupational health. This qualitative study therefore aimed assessing (1) content-related and (2) functional requirements that psychotherapists and occupational health professionals expect from an electronic handover system to exchange relevant information about their patients with common mental disorders.MethodsFive focus groups with psychotherapists and occupational health professionals (occupational physicians and members of company integration management) were conducted via video conference using an interview guide. The focus groups were transcribed and content-analysed using MAXQDA.ResultsWith regard to content-related requirements, information that serve to assess employee's ability to work was described as particularly relevant by occupational physicians and members of company integration management (e.g. restrictions in certain work areas or ability to work under time pressure). Psychotherapists indicated that information about the employee's working conditions is particularly relevant. This includes description of work tasks or conflicts at the workplace. Concerning functional requirements, all professional groups attached importance to data security and functions to improve communication and collaboration (e.g. the use of standardised handover forms).ConclusionThis study provides insight into the desired content-related and functional requirements by psychotherapists, occupational physicians and members of company integration management for an electronic handover system. However, the theoretical and practical development of such a system requires several additional steps, such as the involvement of further relevant stakeholders (e.g. patients, software developers).
| S-EPMC9403231 | biostudies-literature
Project description:BACKGROUND:The Association of American Medical Colleges (AAMC) includes the ability to collaborate in an interprofessional team as a core professional activity that trainees should be able to complete on day 1 of residency (Med Sci Educ. 26:797-800, 2016). The training that medical students require in order to achieve this competency, however, is not well established (Med Sci Educ. 26:457-61, 2016), and few studies have examined non-physician healthcare professionals' perspectives regarding resident physicians' interprofessional skills. OBJECTIVE:This study aims to describe non-physicians' views on barriers to collaboration with physicians, as well as factors that contribute to good collaborative relationships. PARTICIPANTS:Nurses, social workers, case managers, dietitians, rehabilitation therapists, and pharmacists at one academic medical center, largely working in the inpatient setting. APPROACH:A qualitative study design was employed. Data were collected from individual interviews and focus groups comprising non-physician healthcare professionals. KEY RESULTS:Knowledge gaps identified as impeding interprofessional collaboration included inadequate understanding of current roles, potential roles, and processes for non-physician healthcare professionals. Specific physician behaviors that were identified as contributing to good collaborative relationships included mutual support such as backing up other team members and prioritizing multidisciplinary rounds, and communication including keeping team members informed, asking for their input, physicians explaining their rationale, and practicing joint problem-solving with non-physicians. CONCLUSIONS:Discussion of how physician trainees can best learn to collaborate as members of an interprofessional team must include non-physician perspectives. Training designed to provide medical students and residents with a better understanding of non-physician roles and to enhance mutual support and communication skills may be critical in achieving the AAMC's goals of making physicians effective members of interprofessional teams, and thus improving patient-centered care. We hope that medical educators will include these areas identified as important by non-physicians in targeted team training for their learners.
| S-EPMC5880757 | biostudies-literature
Project description:BackgroundThe project "Quality Assurance in Ambulatory Psychotherapy in Bavaria" (QS-PSY-BAY) focuses on the quality assurance of outpatient psychotherapy (OPT) in Germany in terms of symptom reduction and cost reduction under naturalistic conditions. In this study, we examined the effectiveness of psychotherapy in terms of pre-post cost reduction.MethodThe health-care costs of N?=?22,294 insurants over a 5-year period were examined in a naturalistic longitudinal design. Six participating health insurance funds provided data on costs related to inpatient treatment, outpatient treatment, drugs, and hospitalization and work disability days.ResultsWe found that the average annual total costs for inpatient and outpatient treatments as well as drug costs and work disability days increased from the second to the first year before OPT. Besides a large and significant reduction of work disability days (41.8%), hospitalization days (27.4%), and inpatient costs (21.5%) from the first year before versus the first year following OPT, we found evidence for long-term effects: the number of work disability days in the second year after OPT was lower (23.8%), and drug costs were higher than in the second year before OPT (41.5%).ConclusionWe conclude that OPT as a part of the health insurance system is an investment which can pay off in the future especially in terms of lower inpatient costs and work disability.
| S-EPMC4904013 | biostudies-literature
Project description:BackgroundDespite increasing evidence for the effectiveness of psychotherapy for Borderline Personality Disorder (BPD), estimates show that approximately half of those in treatment do not clinically improve or reach reliable change criteria. There are limited qualitative descriptions of treatment factors associated with non-response from the perspectives of those struggling to improve.MethodEighteen people (72.2% female, mean age 29.4 (SD = 8)) with experience of receiving psychotherapeutic treatment for BPD were interviewed to obtain their perspectives on hindering factors in treatment and what may be helpful to reduce non-response. The data in this qualitative study was analysed thematically.ResultsFour domains were created from the insights patients shared on non-response and what may be needed to mitigate it. The focus of Domain 1 was that therapy cannot be effective until two factors are in place. First, the patient needs sufficient safety and stability in their environment in order to face the challenges of therapy. Second, they need to be able to access therapy. Domain 2 described factors the patients themselves contribute. The themes in this domain were described as phases that need to be progressed through before therapy can be effective. These phases were ceasing denial that help is warranted and deserved, taking responsibility for behaviours that contribute to unwellness, and committing to the hard work that is required for change. Domain 3 described how the lack of a safe alliance and ruptures in the safety of the relationship with the therapist can contribute to non-response. Domain 4 was comprised of factors that patients identified as supportive of moving through the barriers to response. The first theme in this domain was prioritising the safety of the therapy relationship. The second theme was giving a clear diagnosis and taking a collaborative approach in sessions. The final theme described the importance of focusing on practical goals with the patient to create tangible life changes.ConclusionThis study found that non-response is complex and multifaceted. First, it is clear that systems need to be in place to support access to adequate care and foster life stability. Second, considerable effort may be needed at the engagement phase of therapy to clarify expectations. Third, attention to specific interpersonal challenges between patients and therapists is an important focus. Finally, structured work to improve relationships and vocational outcomes is indicated.
| S-EPMC10114439 | biostudies-literature
Project description:ObjectiveThere have been few descriptions of how outpatient cancer care is provided to patients from culturally and linguistically diverse (CALD) communities. As populations who experience disparities in cancer care access and outcomes, deeper understanding is needed to help identify those factors which can shape the receipt of multidisciplinary care in ambulatory settings. This paper reports on data collected and analysed as part of a multicentre characterisation of care in Australian public hospital cancer outpatient clinics (OPCs).ResultsAnalysis of data from our ethnographic study of four OPCs identified three themes: "Identifying CALD patient language-related needs"; "Capacity and resources to meet CALD patient needs", and "Making it work for CALD communities." The care team comprises not only clinicians but also families and non-clinical staff; OPCs serve as "touchpoints" facilitating access to a range of therapeutic services. The findings highlight the potential challenges oncology professionals negotiate in providing care to CALD communities and the ways in which clinicians adapt their practices, formulate strategies and use available resources to support care delivery.
| S-EPMC8350263 | biostudies-literature
Project description:BackgroundPerioperative medicine services for older surgical patients are being developed across several countries. This qualitative study aims to explore geriatricians' perspectives on challenges and opportunities for developing and delivering integrated geriatrics perioperative medicine services.MethodsA qualitative phenomenological semi-structured interview design. All geriatric medicine departments in acute public hospitals across Australia and New Zealand (n = 81) were approached. Interviews were conducted with 38 geriatricians. Data were analysed thematically using a framework approach.ResultsGeriatricians identified several system level barriers to developing geriatrics perioperative medicine services. These included lack of funding for staffing, encroaching on existing consultative services, and competing clinical priorities. The key barrier at the healthcare professional level was the current lack of clarity of roles within the perioperative care team. Key facilitators were perceived unmet patient needs, existing support for geriatrician involvement from surgical and anaesthetic colleagues, and the unique skills geriatricians can bring to perioperative care. Despite reporting barriers, geriatricians are contemplating and implementing integrated proactive perioperative medicine services. Geriatricians identified a need to support other specialties gain clinical experience in geriatric medicine and called for pragmatic research to inform service development.ConclusionsGeriatricians perceive several challenges at the system and healthcare professional levels that are impacting current development of geriatrics perioperative medicine services. Yet their strong belief that patient needs can be met with their specialty skills and their high regard for team-based care, has created opportunities to implement innovative multidisciplinary models of care for older surgical patients. The barriers and evidence gaps highlighted in this study may be addressed by qualitative and implementation science research. Future work in this area may include application of patient-reported measures and qualitative research with patients to inform patient-centred perioperative care.
| S-EPMC7816344 | biostudies-literature