Das Konsiliarverfahren in der ambulanten Psychotherapie

Prior to outpatient psychotherapy by a psychotherapist or pediatric psycotherapist, a medical consultation report must be obtained in accordance with the psychotherapy guidelines (PT-RL). The contents of the consultation report are specified in the PT-RL.

The aim of this study was to compare the medical consultation reports with the requirements of the PT-RL and with the corresponding psychotherapeutic reports using real-world data.

In a random sample of 1000 applications for psychotherapy, 380 medial consultation reports were available. The data were extracted from the medical consultation reports and compared with the specifications of the PT-RL using frequency measures. Differences between the medical consultation reports and the psychotherapeutic reports regarding treatment-relevant parameters were analyzed using χ²-tests. Possible predictors for the recommendation of medical cotreatment were analyzed using logistic regression.

The most frequent information provided was on current complaints (79%) and the least frequent was regarding differential and suspected diagnoses (4%). Half of the consultant physicians (49%) did not consider a psychiatric assessment to be necessary, while around one third (29%) did not provide any such assessment. Concerning relevant preliminary and parallel treatments, the medical consultation reports contained this information 2.6 times less frequently than the psychotherapeutic reports (χ² = 22.1; p < 0.001). No evidence of predictors for the recommendation of medical cotreatment was found.

The requirements of the medical consultant reports were only partially fulfilled. In the course of the reform of the German assessment procedure for outpatient psychotherapy the necessity of the consultation reports should be reviewed.