Discussion
guilt, strokes, stress disorder, PTSD, depressive symptoms, trauma
HEART ATTACKS, STROKES
This explorative qualitative study investigated patient reported factors of the interventions acceptance in eight sociodemographic diverse patients, who received a brief study intervention by their GP based on the NET in the PICTURE trial. We identified four main categories which strongly influence acceptance and perceived effectiveness of the intervention that are associated with the role of the GP: 1) long-term trustful relationship between patient and the GP team 2) medical doctor applies the intervention 3) professional emotional distance of the GP team 4) brevity of the intervention.Patients suffering from PTSD often show behaviour of avoidance, as well as unspecific symptoms like sleep disturbances, exhaustion, feelings of guilt, depressive symptoms [Consequently, patients with PTSD after ICU are treated mainly in general practice. The long-standing trusting relationship provides support and structure, as well as the low-threshold opportunity to address worries and problems. In our study, five out of eight patients addressed the trusting relationship to their GP as supporting factor to face up with their ICU memories and to enter a brief psychological intervention. The diagnostics and the first low-threshold treatment of mental health symptoms should therefore definitely be offered in the setting of GP. This approach has also been established in other areas of mental health [In addition, GPs can use their medical expertise when talking with patients about their ICU stays [In our study half of the patients interviewed explicitly appreciated the medical expertise of the GP. The medical knowledge of the GP might be especially welcomed for the treatment of medical-related trauma topics (e.g. surgeries, heart attacks, strokes etc.). However, one patient was critical of the less psychotherapeutic counselling techniques of his GP. If the NET would to be integrated in routine primary care, practical exercises and supervision by a NET specialist need to be standardized part of GP.When the patient is discharged home or to a long-term care facility, patient-centered communication and provision of information again are key to prepare the patient, family, and the primary care team for this next phase of the continuum [The professional emotional distance of the GP team might be very helpful, to talk unconditional about personal emotions, without the additional burden of worrying about a close relative [Of course, the presented intervention applied by a GP team has not been designed to replace psychotherapy, but to assist those who do not have immediate access to this care. In addition, low-threshold support might not only address the patients themselves, but also relatives and families.Several limitations of the intervention have been mentioned by the patients. The brevity of the study intervention was explicitly emphasized as negative by two patients. Both respondents were affected by several stressful hospital stays as part of their underlying illness and had comparably very high values in the posttraumatic diagnostic scale (PDS-5) scoring. As they were still suffering from moderate PTSD-symptoms, they do not necessarily require a comprehensive trauma therapy. Severely affected patients, should consider the intervention only as a transitional offer. In such cases, further long-term trauma-focused psychotherapy provided by a specialist might be necessary [Patients with mild to moderate PTSD symptoms may recover by NET. It is therefore of the utmost importance to inform outpatient care providers about the clinical signs, symptoms and simple treatment options of mild to moderate PTSD symptoms. Furthermore, they should be informed about somatic indications of a possible stress disorder after ICU.Timely access to effective treatment is a primary challenge in mental health services. However, when demand exceeds available resources, services may place clients on a waitlist or restrict services [