Feasibility of a conversation-based brief intervention in general practice to reduce post-traumatic symptoms after intensive care treatment : a qualitative analysis of the PICTURE study

Abstract

There is currently a gap in the follow-up care of patients with post-traumatic stress disorder (PTSD) after intensive care. Long-term care is mainly provided within the setting of general practice. A conversation-based brief intervention carried out by general practitioners improved the symptoms of mild to moderate post-traumatic stress disorder sustainably. The aim of this study is to assess the subjective effectiveness and feasibility of short-term, primary care-based narrative exposure intervention from the perspective of participating general practitioners. Process-accompanying follow-up calls were made to all general practitioners in the intervention group to check the feasibility of the intervention and to reinforce the initial training. The survey was conducted by telephone between the second and third intervention sessions using an open-response questionnaire. The data analysis was carried out using the structuring qualitative content analysis according to Kuckartz. A total of N = 93 protocols from 87 general practitioners were analyzed. The intervention was assessed as useful and effective by most general practitioners. Nearly half of respondents considered permanent implementation in everyday practice, another third with certain limitations. The good learnability and practicability of the intervention as well as the patient’s need were cited as beneficial factors. The greatest barriers to feasibility were seen in the high time expenditure and the lack of remuneration in standard care. Given the shortage of follow-up care for post-ICU PTSD symptoms and the substantial waiting times for trauma-focused psychotherapy, this low-threshold intervention delivered by general practitioners appears both feasible and well-positioned to help bridge a critical gap in care. Since the general practitioners surveyed emphasized the advantage of a quick and low-threshold treatment option for the care of patients with symptoms of PTSD after a stay on an intensive care unit, it seems sensible to ensure that general practitioners have access to training opportunities in the future. Additionally, diagnostics for Post-Intensive Care Syndrome should be implemented after intensive care.