Killaspy H, Banerjee S, King M, Lloyd M
University Department of Psychiatry, Royal Free Hospital School of Medicine, London.
Br J Gen Pract. 1999 Nov;49(448):880-3.
What should happen when an outpatient fails to attend a psychiatric clinic? Guidelines from the General Medical Services Committee suggest that general practitioners (GPs) have no further responsibility of care for a patient once a referral to a psychiatrist has been made. This raises questions about the formulation of effective management plans for those patients with whom psychiatric services find it difficult to engage due to non-compliance with assessment and follow-up.
To investigate communication between GPs, patients, and psychiatrists at referral and following attendance or non-attendance at outpatient appointments.
A prospective study of a random sample of attenders and non-attenders at psychiatric outpatient clinics. Patients and GPs were interviewed to obtain data about the referral process. GPs' views on communication from psychiatrists and the appropriate course of action following clinic non-attendance were investigated. The quality of referral and clinic letters for attenders and non-attenders was compared.
There was no difference in the quality of referral letter for attenders and non-attenders. Psychiatrists were less likely to write to GPs about follow-up patients' appointments than new patients' appointments; communication was least likely when a follow-up patient missed their appointment. GPs considered follow-up non-attenders were more likely to need a further appointment than new patient non-attenders, but did not identify a role for themselves in engaging with follow-up non-attenders.
Communication between GPs and psychiatrists about new patients seems adequate. However, there are important deficits in communication from psychiatrists to GPs about follow-up patients, especially non-attenders who are often more severely ill and difficult to engage. An effective response for this group is likely to need cooperative health and social service action rather than rigid guidelines concerning clinical responsibility.
门诊患者未前往精神科诊所就诊时应如何处理？英国国家医疗服务体系全科医疗服务委员会的指南指出，一旦将患者转诊至精神科医生处，全科医生（GP）便不再负有进一步的护理责任。这引发了一些问题，即对于那些因不配合评估和随访而导致精神科服务难以接触到的患者，如何制定有效的管理计划。
调查全科医生、患者和精神科医生在转诊时以及门诊预约就诊或未就诊后的沟通情况。
对精神科门诊诊所的就诊者和未就诊者进行随机抽样的前瞻性研究。对患者和全科医生进行访谈以获取转诊过程的数据。调查全科医生对精神科医生沟通情况的看法以及诊所未就诊后的适当行动方案。比较就诊者和未就诊者转诊信和诊所信件的质量。
就诊者和未就诊者的转诊信质量没有差异。与新患者预约相比，精神科医生不太可能就随访患者的预约情况写信给全科医生；当随访患者错过预约时，沟通的可能性最小。全科医生认为，随访未就诊者比新患者未就诊者更有可能需要再次预约，但未确定自己在与随访未就诊者接触中的角色。
全科医生和精神科医生之间关于新患者的沟通似乎是充分的。然而，精神科医生与全科医生之间关于随访患者的沟通存在重要缺陷，尤其是那些病情往往更严重且难以接触的未就诊者。对于这一群体，有效的应对措施可能需要卫生和社会服务部门的合作行动，而不是关于临床责任的严格指南。
