Verhaak Peter F M, van den Brink-Muinen Atie, Bensing Jozien M, Gask Linda
NIVEL, Netherlands institute for health services research, Utrecht, The Netherlands.
Eur J Public Health. 2004 Jun;14(2):134-40. doi: 10.1093/eurpub/14.2.134.
The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system. This may influence patients' expectations and requests for help and GPs' performance. In this paper the effects of working in different health care systems on demand and supply for psychological help were examined.
Data were collected in six European countries with different health care system characteristics (Belgium, Germany, The Netherlands, Spain, Switzerland and the UK). For 15 consecutive contacts with 190 GPs in the six countries, each patient completed questionnaires concerning reason for visit and expectations (before) and evaluation (after consultation). General practitioners completed registration forms on each consultation, indicating familiarity with the patient and diagnosis. General practitioners completed a general questionnaire about their personal and professional characteristics as well.
Practices in different countries differed considerably in the proportion of psychological reasons for the visit by the patient and psychological diagnoses by the GP. Agreement between patients' self-rated problems and GPs' diagnoses also varied. Patients in different countries evaluated their GPs' psychological performance differently as well, but evaluation was not correlated with agreement between request for help and diagosis. In gatekeeping countries, patients had more psycho-social requests, GPs made more psychological diagnoses and agreement between both was relatively high. Evaluation, however, was more positive in non-gatekeeping countries. Individual characteristics of doctors and patients explained only a relatively small part of variance.
Health care system characteristics do affect GPs' performance in psycho-social care.
全科医生通常是精神问题患者的首个医疗接触对象。全科医生的地位在不同医疗体系中可能有所不同，这取决于转诊系统（守门人模式与直接就诊专家模式）、是否有固定名单以及支付系统。这可能会影响患者的期望、求助请求以及全科医生的表现。本文研究了在不同医疗体系中工作对心理帮助的需求和供给的影响。
在六个具有不同医疗体系特征的欧洲国家（比利时、德国、荷兰、西班牙、瑞士和英国）收集数据。针对六个国家的190名全科医生连续15次诊疗接触，每位患者填写了关于就诊原因和期望（就诊前）以及评估（会诊后）的问卷。全科医生在每次会诊时填写登记表，注明对患者的熟悉程度和诊断结果。全科医生还填写了一份关于其个人和专业特征的一般问卷。
不同国家的诊疗实践在患者就诊的心理原因比例和全科医生的心理诊断方面存在很大差异。患者自评问题与全科医生诊断之间的一致性也各不相同。不同国家的患者对全科医生心理表现的评价也不同，但评价与求助请求和诊断之间的一致性无关。在守门人模式国家，患者有更多心理社会方面的求助请求，全科医生做出更多心理诊断，两者之间的一致性相对较高。然而，在非守门人模式国家，评价更为积极。医生和患者的个体特征仅解释了相对较小的差异部分。
医疗体系特征确实会影响全科医生在心理社会护理方面的表现。
