Andrés Steffanowski

Benefits and challenges in practice-oriented psychotherapy research in Germany: The TK and the QS-PSY-BAY projects of quality assurance in outpatient psychotherapy

Abstract Objective: Two patient-focused long-term research projects performed in the German outpatient psychotherapy system are focused on in this article. The TK (Techniker Krankenkasse) project is the first study to evaluate a quality assurance and feedback system with regard to its practical feasibility in German routine care. The other study (“Quality Assurance in Outpatient Psychotherapy in Bavaria”; QS-PSY-BAY) was designed to test a new approach for quality assurance in outpatient psychotherapy using electronic documentation of patient characteristics and outcome parameters. In addition this project provides the opportunity to analyze data on health-related costs for the patients undergoing outpatient psychotherapy. Method: Both projects and their results indicating high effect sizes are briefly described. Results: From the perspectives of the research teams, advisory boards and other stakeholders, the experiences with these projects are discussed focusing on obstacles, challenges, difficulties, and benefits in developing and implementing the studies. The triangle collaboration of therapists, researchers, and health insurance companies/health service institutions turned out to be fruitful in both studies. Conclusions: Despite some controversies between the partners the experiences indicate the importance of practiced-research collaborations to provide relevant information about the delivery of outpatient psychotherapy in the health system.

Abbrüche antragspflichtiger ambulanter Psychotherapien: Häufigkeit, Risikofaktoren, Outcome

OBJECTIVE Because premature discontinuation of psychotherapy limits the effectiveness of the interventions, in a naturalistic design we examined the prevalence, predictors, and outcome of premature discontinuation. METHODS The sample included N = 584 patients with various mental disorders. Risk factors were identified using regression analysis. As outcome Patient Health Questionnaire scales were considered. We compared pre and post averages as well as post averages of premature discontinuation versus regular termination. RESULTS Risk factors were: female and/or unemployed patient, low patient and/or therapist ratings regarding therapy success, and extraordinarily high therapist ratings of the therapeutic alliance. Despite premature discontinuation we found significant reductions of depression, anxiety, somatic symptoms, and stress (ES = 0.30, …, 0.44). Compared to regular termination though, patients with premature discontinuation were more impaired at last measurement (ES = 0.17, …, 0.37). CONCLUSION Not each premature discontinuation is a psychotherapeutic failure. Warning signals for looming premature discontinuation are low ratings of therapy success while psychotherapeutic treatment.

Das Modellprojekt der TK zum Qualitätsmonitoring in der ambulanten Psychotherapie aus Sicht der Evaluatoren – Ein Plädoyer für mehr Psychotherapieforschung in Deutschland

This commentary discusses the view of the evaluation team on the first study in Germany to evaluate a new quality assurance and feedback tool with regard to its practical feasibility in routine care. The representative of the sample is issued and design topics which made it necessary to control for differences of approved ses-sions between control and intervention groups are explained. Key findings of the study are the high patient satisfaction in the feedback condition, the acceptance of feedback as well as the use of the feedback system by therapists. It is argued, that an extension of psychotherapy research into routine practice is necessary to hold the high standard of the German service system and that the establishment of an ongoing progress monitoring in real world psychotherapy would have several benefits for patients, therapists and researchers.

P02-143 - Quality assurance in ambulatory psychotherapy: designs, tools and first results

Client and therapist document the therapy process using handheld computers by answering questions about symptom severity (e.g. depression, anxiety and stress), life satisfaction, therapeutic relationship and problem domains. The encrypted data is sent to the University of Mannheim via internet, where the data is analyzed by specific software. As a response for each data delivery, the therapist gets an individual feedback report, monitoring the therapy process of all of his / her patients in comparison to reference groups, build by the steady growing database of the trustcenter. The KVB provides the documentation software and handheld computers for a sample of 200 psychotherapists. 1694 patients participate in the prospective naturalistic study and 1091 patients have completed their therapy so far. As from now the first 1-year-follow-up measures are done. For outcome evaluation, an overall index of outcome quality is computed, aggregating single pre-post-measures to a multiple outcome criterion. 76.8% of the 1694 patients at intake are female; the age mean is 40.2 years (SD = 12.3). About 48.4% suffer from depressive disorders, followed by anxiety disorders (18.9%). Outcome results demonstrate impressive effect sizes (Cohens d = 0.87) at discharge on a multiple outcome criterion. Electronic documentation is well accepted by most of the participating therapists. The encrypted computer based documentation is a secure and comfortable approach to improve transparency for therapists and patients. It provides useful information for therapy process optimization and outcome documentation of therapy results.