[Treatment recommendations in psychosomatic rehabilitation -- empirical analyses based on the pension insurers' standardized discharge report].
BACKGROUND
The recommendations for aftercare listed in discharge reports represent a core component of communication between inpatient psychosomatic rehabilitation and ambulatory follow-up care. The standardized discharge report used by the pension insurance institutes makes use of a generic category system for systematization and simplification of recommendations for aftercare. Neither the practice of making recommendations for aftercare as observed by therapists and physicians responsible for treatment in the inpatient setting nor the appropriateness and differentiation of the category system has previously been systematically examined. A randomized sample of discharge reports was analyzed for this purpose.


METHODS
A sample of 500 discharge reports from an inpatient-oriented psychosomatic rehabilitation setting were analyzed regarding the categories of recommended aftercare measures and their relationship with socio-demographic variables, clinical diagnosis and sociomedical variables.


RESULTS
Outpatient psychotherapy represents the most frequently recommended aftercare treatment, being suggested in nearly 70% of the patients. Further substantial percentages were found in recommendations for areas including occupational rehabilitation, somatic-medical recommendations, and recommendations for health behaviour and self-help groups. In approximately one quarter of the patients, recommendations for aftercare were given that were coded under the category of "other suggestions". In younger and socio-medically burdened patients, recommendations for the fields of occupational rehabilitation and psychotherapy were more frequently given. In patients with a somatic illness or a somatoform disorder as the primary diagnosis, recommendations within the field of outpatient psychotherapy were found less frequently, while recommendations in the somatic-medical area were more commonly found.


CONCLUSIONS
The results give some support for the clinical validity of the form of recommendations given for aftercare measures in an inpatient psychosomatic rehabilitation setting. At the same time, the analyses indicate excessive as well as insufficient differentiation in the generic category system for follow-up treatment recommendations, which could lead to a loss of valuable information at the interface between inpatient and outpatient treatments.
Harfst
T
T
Klinik und Poliklinik für Innere Medizin, Abteilung Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf. harfst@uke.uni-hamburg.de
Koch
U
U
Schulz
H
H
D000328:Adult; D000359:Aftercare; D000553:Ambulatory Care; D003131:Combined Modality Therapy; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010351:Patient Discharge; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D011613:Psychotherapy; D012047:Rehabilitation Centers; D012943:Social Security