Hessian GP surgeons break new areas to help people with depression and anxiety disorder.
Volker M. is a powerful man. However, what you do not see: it suffers from panic attacks, anxiety and depression. Three years ago, after his parents died, "I fell into a deep hole," says the 56-year-old. Motorcycle, his great passion "is now empty". She is feeling better from being in the day-care clinic, but she needs constant help. He was looking for a psychotherapist for a year. Now she hopes to find help in the practice of her family doctor.
Psychotherapy at a family doctor? This acts as a test for 2000 patients in Hessen. A pilot project started. WHO states that it is committed to "managing an e-health case for mentally ill persons in primary health care". The National Innovation Fund, which can test new ways in healthcare, promotes a project with just five million euros. It is performed exclusively in Hessen.
Practice Christiane Kunz and Martine Voß in Frankfurt-Zeilsheim is one of the first to join PREMI. "Initial contact is always with us," says Dr. Sc. Kunz. "We're talking to patients." Often patients come with physical pain: exhaustion, stomach or back pain are classic. An experienced physician often sees: "If the clinical picture is cloudy, perhaps behind it is something else."
Patients do not always need psychotherapy immediately – and if they do, they often have to wait a long time. In the meantime, so hopefully, the family doctor's office can support the patients. The program lasts for one year and consists of three components: talk with a doctor, telephone calls and "homework" on the computer.
An important role in the program is medical assistants (MFA). They used to call them at the receptionists – PREMAs are "Case Managers". They regularly call the patients together with the questionnaire. Do you have a sleep problem? Do you feel like you have no energy? Do you have any thoughts on death?
Patients feel good
Daniela Wölk, MVP in Zeilsheim's practice, was already involved in PREMA's preliminary study of PROMPT 2004. Her experience: "Patients felt good." Answers that come from zero to three on the computer. "Frequently, patients talk a lot – more than they told the doctors," says Wölk. "Light" means whether the patient is better, more stable or worse. If the traffic light is red, the doctor is on.
The third building blocks are home computer exercises. Patients with anxiety disorders, for example, are instructed to consciously activate physical reactions in the event of a panic attack. "Patient learns: I can control it and lose again," explains prof. Jochen Gensichen, director of the Institute of General Medicine of the University of Munich, who developed the PREMA. For Depression, the program offers exercises for better perception of your body, or suggestions for "goals of enjoyment in everyday life".
The Hesse Psychiatric Chamber thinks the offer is very critical. Well, the Chamber finds that family physicians pay more attention to the symptoms of mental illness. Even with self-education on a computer, professionals have no problem. Psychotherapists believe that the role of the MFA is "very problematic": "Mental illness is not a simple mental disorder that can be treated with kind words."
Participants of the project are Techniker Krankenkasse, Kassenärztliche Vereinigung, TelePsy Technology Provider and several universities that scientifically support the project. It is estimated whether the program helps the patient, whether it is accessible to the practitioner and what the costs are.
Volker M. does not know exactly what to expect. Especially among the things he should do on the computer, he can not imagine much. "But I'm open to everything," says the driver with a disability. In his family practice, he feels good: "It's not all that fun now, but thanks to the women I've been through, I've come through pretty good life." (AP)