Raine R, Lewis L, Sensky T, Hutchings A, Hirsch S, Black N
Health Services Research Unit, London School of Hygiene and Tropical Medicine.
Br J Gen Pract. 2000 Aug;50(457):620-5.
A large proportion of a general practitioner's (GP's) caseload comprises patients with mental health problems. It is important to ensure that care is provided appropriately, on the basis of clinical need. It is therefore necessary to investigate the determinants of the use of mental health care in the primary care sector and, in particular, to identify any non-clinical characteristics of patients that affect the likelihood of their receiving appropriate care.
To identify and compare the influence of non-clinical patient factors on GPs' acknowledgement of mental problems and on their provision of mental health care.
Cross sectional study of adults aged 16 to 65 years old (n = 802) attending one of eight practices (20 GPs in total) in inner west London.
Multivariable analysis showed that the combination of factors that best predict GPs' acknowledgement of the presence of mental problems are general health questionnaire (GHQ) scores (odds ratio [OR] = 1.10 per unit increase in score, 95% confidence interval [CI] = 1.07 to 1.13), previous mental symptoms (OR = 7.5, 95% CI = 4.3 to 12.9), increasing age (OR = 1.03 per one-year increase, 95% CI = 1.01 to 1.04) and physical health status (OR = 0.98 per unit increase in short form-36 (SF-36) score, 95% CI = 0.96 to 1.00). Multivariable analysis showed that the combination of factors that best predict intervention (prescription for psychotropic medication; return visit to GP; referral to psychiatric inpatients/outpatients; referral to other [specified] health professionals, or social services) are previous symptoms (OR = 7.4, 95% CI = 3.8 to 14.4), white ethnic group (OR = 2.2, 95% CI 0.9 to 5.5); and not owning a property (OR = 2.1, 95% CI = 1.1 to 4.0). Life events influenced intervention only in the presence of low GHQ scores (OR = 8.1, 95% CI = 2.7 to 24.0).
Mental problems are common in primary care and their acknowledgement is a necessary but not a sufficient condition for intervention. Our results show that GPs' decisions about mental health interventions can be influenced by non-clinical patient factors, regardless of patients' clinical needs. The results suggest that current practice may not always be equitable, and point to the need for better understanding of the basis of these potential inequalities and for focused training.
全科医生（GP）的大部分工作量是患有心理健康问题的患者。基于临床需求确保提供适当的护理非常重要。因此，有必要调查基层医疗部门使用心理健康护理的决定因素，特别是要确定影响患者获得适当护理可能性的任何非临床特征。
确定并比较非临床患者因素对全科医生对心理问题的认知及其提供心理健康护理的影响。
对伦敦内西区8家诊所（共20名全科医生）中16至65岁的成年人（n = 802）进行横断面研究。
多变量分析表明，最能预测全科医生对存在心理问题认知的因素组合是一般健康问卷（GHQ）得分（得分每增加一个单位，优势比[OR]=1.10，95%置信区间[CI]=1.07至1.13）、既往心理症状（OR = 7.5，95% CI = 4.3至12.9）、年龄增长（每增加一岁，OR = 1.03，95% CI = 1.01至1.04）和身体健康状况（简短健康调查问卷-36[SF-36]得分每增加一个单位，OR = 0.98，95% CI = 0.96至1.00）。多变量分析表明，最能预测干预措施（精神药物处方；复诊全科医生；转诊至精神科住院/门诊患者；转诊至其他[指定]健康专业人员或社会服务机构）的因素组合是既往症状（OR = 7.4，95% CI = 3.8至14.4）、白人种族（OR = 2.2，95% CI 0.9至5.5）；以及没有房产（OR = 2.1，95% CI = 1.1至4.0）。生活事件仅在GHQ得分较低的情况下影响干预措施（OR = 8.1，95% CI = 2.7至24.0）。
心理问题在基层医疗中很常见，对其的认知是干预的必要但非充分条件。我们的结果表明，全科医生关于心理健康干预的决定可能受到非临床患者因素的影响，而与患者的临床需求无关。结果表明当前的做法可能并不总是公平的，并指出需要更好地理解这些潜在不平等的基础以及进行有针对性的培训。
