LAUSR

ZusammenfassungHintergrundZiel war die Darstellung schmerz- und palliativmedizinischer Strukturen anästhesiologischer Abteilungen in deutschen Krankenhäusern.MethodeAlle bei der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) erfassten anästhesiologischen Chefärztinnen und Chefärzte wurden anhand eines Fragebogens zu Schmerz- und Palliativmedizin in ihren Kliniken befragt.ErgebnisseVon 408 zurückgesendeten Fragebogen (Rücklauf 47 %) waren 403 auswertbar. In 58 % der Krankenhäuser gab es eine ausgewiesene schmerzmedizinische Versorgung, in 36 (9 %) aller Krankenhäuser als eigenständige Abteilung und in 195 (57 %) als Teilbereich einer Abteilung, meist der Anästhesiologie. Die „Schmerzambulanz“ war die häufigste Organisationsform für die Schmerzmedizin (41 %); die tagesklinische Schmerztherapie war bundesweit wenig vertreten (7 %). Es bestanden Defizite hinsichtlich Organisation und Qualifikation in den Einrichtungen (z. B. kein Arzt mit Zusatzbezeichnung spezielle Schmerztherapie oder kein Psychologe in Einrichtungen zur multimodalen Schmerztherapie). Es hatten 16 % der Krankenhäuser eine eigene Abteilung für Palliativmedizin, in 32 % war die Palliativmedizin in eine andere Abteilung integriert, davon in 30 % in die Anästhesiologie. Von den Krankenhäusern hatten 56 % einen palliativmedizinischen Konsiliardienst, 41 % palliativmedizinische Betten, 6 % eine Ambulanz, 4 % eine Tagesklinik, und an 16 % war eine spezialisierte ambulante Palliativversorgung (SAPV) angegliedert. Innerklinische Dienste und SAPV gab es häufiger, wenn die Anästhesiologie an der Palliativmedizin beteiligt war.SchlussfolgerungIn Krankenhäusern trägt die Anästhesiologie zu einem erheblichen Teil zu Schmerz- und Palliativversorgung bei. Dennoch fehlt es oft an entsprechenden Versorgungsstrukturen.AbstractBackgroundThe aim of this analysis was to describe the role of anesthesiology departments in pain medicine and palliative care services in German hospitals.MethodIn the year 2012, all heads of departments of anesthesiology registered with the German Society of Anesthesiology and Intensive Care Medicine were surveyed about structures of pain medicine and palliative care services in their hospitals using a standardized postal questionnaire.ResultsOut of 408 returned questionnaires (response rate 47%) 403 could be evaluated. Of the hospitals 58% had a designated pain medicine service, in 36 (9%) of the hospitals this was organized as an independent department and in 195 (57%) as part of another department, mostly the department of anesthesiology. The “pain clinic” as an outpatient service was the most common form of structure for pain medicine services (41%). Inpatient pain medicine units were available in 77 (19%) of the hospitals and a partial inpatient unit in the form of a day hospital in 26 (7%) of the hospitals. For the care of inpatients from other departments, there was an intrahospital pain consultation service in 166 of the hospitals, which was the only structure for pain medicine in 32 of the 231 hospitals that reported having a designated pain medicine service. In 160 pain medicine services anesthesiologists were the only medical practitioners and in a further 18 both anesthesiologists and other specialists were available (orthopedist/orthopedic surgeons n = 6, internal medicine n = 4, psychiatrist n = 2, general practitioner = 1 and neurologist n = 1). Only two hospitals had no anesthesiologist in the pain medicine team and for the remaining 51 hospitals no information was provided. In 189 of the 231 hospitals with pain medicine services, there was at least 1 physician with special qualifications in pain management. In 97 (44%) of the hospitals psychologists were part of the team with 53 having at least 1 psychologist with a special qualification in chronic pain management. Of the hospitals, 16% had a specialized department for palliative care, in 32% a specialized palliative care service was part of another department, which was the department of anesthesiology in 30%. Of the hospitals 56% had a palliative care consultation service, 41% had a specialized inpatient palliative care unit, 6% an outpatient clinic, 4% a day hospital and in 16% a specialized outpatient palliative care (SOPC) serving the community was incorporated. Inpatient consultation services and the SOPC were more common when the department of anesthesiology was involved in the palliative care services.ConclusionIn German hospitals, the departments of anesthesiology make a significant contribution to the provision of both pain medicine and palliative care services. Nevertheless, the respective structures of care are often incomplete or even lacking. There were shortcomings in terms of organization and qualification of the team in pain medicine services (e.g. no doctor with special qualifications in pain management or no psychologist). Palliative care services are more often organized as independent departments than as pain medicine services. Engagement of the anesthesiology department in palliative care is linked to a broader scope of the services provided, which might reflect the capacity of many anesthesiologists to work in an interdisciplinary manner and across interfaces.