Barriers and opportunities for implementation of a brief psychological intervention for post-ICU mental distress in the primary care setting - results from a qualitative sub-study of the PICTURE trial

• Published in: BMC family practice 2023-05, Vol.24 (1), p.113-113, Article 113
• Main Authors: Sanftenberg, Linda, Beutel, Antina, Friemel, Chris Maria, Kosilek, Robert Philipp, Schauer, Maggie, Elbert, Thomas, Reips, Ulf-Dietrich, Gehrke-Beck, Sabine, Schubert, Tomke, Schmidt, Konrad, Gensichen, Jochen
• Format: Article
• Language: English
• Subjects: Analysis; Care and treatment; Case management; Diagnosis; Emotions; Exposure therapy; Female; Humans; Intensive care; Intensive Care Units; Intervention; Interviews; Male; Mental health; Middle Aged; Narrative exposure therapy; Patient outcomes; Patients; Physician and patient; Physician-Patient Relations; Post traumatic stress disorder; Post-intensive care syndrome; Primary care; Primary Health Care; Psychosocial Intervention; Qualitative analysis; Qualitative research; Services; Teams
• ISSN: 2731-4553; 2731-4553; 1471-2296
• DOI: 10.1186/s12875-023-02046-0

The results of critical illness and life-saving invasive measures during intensive care unit treatment can sometimes lead to lasting physical and psychological impairments. A multicentre randomized controlled trial from Germany (PICTURE) aims to test a brief psychological intervention, based on narrative exposure therapy, for post-traumatic stress disorder symptoms following intensive care unit treatment in the primary care setting. A qualitative analysis was conducted to understand feasibility and acceptance of the intervention beyond quantitative analysis of the main outcomes in the primary study. Qualitative explorative sub-study of the main PICTURE trial, with eight patients from the intervention group recruited for semi-structured telephone interviews. Transcriptions were analysed according to Mayring's qualitative content analysis. Contents were coded and classified into emerging categories. The study population was 50% female and male, with a mean age of 60.9 years and transplantation surgery being the most frequent admission diagnosis. Four main factors were identified as conducive towards implementation of a short psychological intervention in a primary care setting: 1) long-term trustful relationship between patient and GP team; 2) intervention applied by a medical doctor; 3) professional emotional distance of the GP team; 4) brevity of the intervention. The primary setting has certain qualities such as a long-term doctor-patient relationship and low-threshold consultations that offer good opportunities for implementation of a brief psychological intervention for post-intensive care unit impairments. Structured follow-up guidelines for primary care following intensive care unit treatment are needed. Brief general practice-based interventions could be part of a stepped-care approach. The main trial was registered at the DRKS (German Register of Clinical Trials: DRKS00012589) on 17/10/2017.