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Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units—A Pilot Study

INTRODUCTION: Specialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor so...

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Autores principales: Köbler, Paul, Krauss-Köstler, Eva K., Stein, Barbara, Ficker, Joachim H., Wilhelm, Martin, Dechêne, Alexander, Waller, Christiane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9039260/
https://www.ncbi.nlm.nih.gov/pubmed/35493384
http://dx.doi.org/10.3389/fpubh.2022.844874
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author Köbler, Paul
Krauss-Köstler, Eva K.
Stein, Barbara
Ficker, Joachim H.
Wilhelm, Martin
Dechêne, Alexander
Waller, Christiane
author_facet Köbler, Paul
Krauss-Köstler, Eva K.
Stein, Barbara
Ficker, Joachim H.
Wilhelm, Martin
Dechêne, Alexander
Waller, Christiane
author_sort Köbler, Paul
collection PubMed
description INTRODUCTION: Specialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor somatic care units alone are appropriate to their needs. The “Nuremberg Integrated Psychosomatic Acute Unit” (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting. METHOD: NIPA has been established in inpatient internal medical wards for respiratory medicine, oncology and gastroenterology. One to two patients per ward are regularly enrolled in the NIPA treatment while remaining in the same inpatient bed after completion of the somatic care. In a naturalistic study design, we evaluated treatment effects by assessment of symptom load at admission and at discharge using the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Furthermore, we assessed the severity of morbidity using diagnosis data during treatment. At discharge, we measured satisfaction with treatment through the Patient Satisfaction Questionnaire (ZUF-8). RESULTS: Data from 41 NIPA patients were analyzed (18–87 years, 76% female). Seventy-eight percent suffered from at least moderate depression and 49% from anxiety disorders. Other diagnoses were somatoform pain disorder, somatoform autonomic dysfunction, eating disorder and posttraumatic stress disorder. Hypertension, chronic lung diseases and musculoskeletal disorders as well as chronic oncological and cardiac diseases were the most common somatic comorbidities. Treatment resulted in a significant reduction of depressive mood (admission: M = 10.9, SD = 6.1, discharge: M = 7.6, SD = 5.3, d = 0.58, p = 0.001), anxiety (admission: M = 10.6, SD = 4.9, discharge: M = 7.3, SD = 4.1, d = 0.65, p< 0.001) and stress (admission: M = 6.0, SD = 3.6, discharge: M = 4.1, SD = 2.5, d = 0.70, p< 0.001). Somatic symptom burden was reduced by NIPA treatment (admission: M = 10.9, SD = 5.8, discharge: M = 9.6, SD = 5.5, d = 0.30), albeit not statistically significant (p = 0.073) ZUF-8 revealed that 89% reported large or full satisfaction and 11% partial dissatisfaction with treatment. DISCUSSION: NIPA acute care is bridging the gap for patients in need of psychosocial treatment with complex somatic comorbidity. Further long-term evaluation will show whether psychosocial NIPA care is able to reduce the course of physical illness and hospital costs by preventing hospitalization and short-term inpatient re-admissions.
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spelling pubmed-90392602022-04-27 Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units—A Pilot Study Köbler, Paul Krauss-Köstler, Eva K. Stein, Barbara Ficker, Joachim H. Wilhelm, Martin Dechêne, Alexander Waller, Christiane Front Public Health Public Health INTRODUCTION: Specialized biopsychosocial care concepts are necessary to overcome the dualism between physical and psychosocial treatment in acute care hospitals. For patients with complex and chronic comorbid physical and mental health problems, neither standardized psychiatric/psychosomatic nor somatic care units alone are appropriate to their needs. The “Nuremberg Integrated Psychosomatic Acute Unit” (NIPA) has been developed to integrate treatment of both, psychosocial and physical impairments, in an acute somatic care setting. METHOD: NIPA has been established in inpatient internal medical wards for respiratory medicine, oncology and gastroenterology. One to two patients per ward are regularly enrolled in the NIPA treatment while remaining in the same inpatient bed after completion of the somatic care. In a naturalistic study design, we evaluated treatment effects by assessment of symptom load at admission and at discharge using the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder Scale-7 (GAD-7). Furthermore, we assessed the severity of morbidity using diagnosis data during treatment. At discharge, we measured satisfaction with treatment through the Patient Satisfaction Questionnaire (ZUF-8). RESULTS: Data from 41 NIPA patients were analyzed (18–87 years, 76% female). Seventy-eight percent suffered from at least moderate depression and 49% from anxiety disorders. Other diagnoses were somatoform pain disorder, somatoform autonomic dysfunction, eating disorder and posttraumatic stress disorder. Hypertension, chronic lung diseases and musculoskeletal disorders as well as chronic oncological and cardiac diseases were the most common somatic comorbidities. Treatment resulted in a significant reduction of depressive mood (admission: M = 10.9, SD = 6.1, discharge: M = 7.6, SD = 5.3, d = 0.58, p = 0.001), anxiety (admission: M = 10.6, SD = 4.9, discharge: M = 7.3, SD = 4.1, d = 0.65, p< 0.001) and stress (admission: M = 6.0, SD = 3.6, discharge: M = 4.1, SD = 2.5, d = 0.70, p< 0.001). Somatic symptom burden was reduced by NIPA treatment (admission: M = 10.9, SD = 5.8, discharge: M = 9.6, SD = 5.5, d = 0.30), albeit not statistically significant (p = 0.073) ZUF-8 revealed that 89% reported large or full satisfaction and 11% partial dissatisfaction with treatment. DISCUSSION: NIPA acute care is bridging the gap for patients in need of psychosocial treatment with complex somatic comorbidity. Further long-term evaluation will show whether psychosocial NIPA care is able to reduce the course of physical illness and hospital costs by preventing hospitalization and short-term inpatient re-admissions. Frontiers Media S.A. 2022-04-12 /pmc/articles/PMC9039260/ /pubmed/35493384 http://dx.doi.org/10.3389/fpubh.2022.844874 Text en Copyright © 2022 Köbler, Krauss-Köstler, Stein, Ficker, Wilhelm, Dechêne and Waller. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Köbler, Paul
Krauss-Köstler, Eva K.
Stein, Barbara
Ficker, Joachim H.
Wilhelm, Martin
Dechêne, Alexander
Waller, Christiane
Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units—A Pilot Study
title Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units—A Pilot Study
title_full Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units—A Pilot Study
title_fullStr Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units—A Pilot Study
title_full_unstemmed Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units—A Pilot Study
title_short Specialized Biopsychosocial Care in Inpatient Somatic Medicine Units—A Pilot Study
title_sort specialized biopsychosocial care in inpatient somatic medicine units—a pilot study
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9039260/
https://www.ncbi.nlm.nih.gov/pubmed/35493384
http://dx.doi.org/10.3389/fpubh.2022.844874
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