Hübner-Liebermann B, Spiessl H, Rogenhofer G, Cording C
Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität am Bezirksklinikum Regensburg Universitätsstrasse 84, D-93053 Regensburg.
MMW Fortschr Med. 2005 Apr 7;147 Suppl 1:7-12.
In the light of the increasing importance of the general practitioner as a gatekeeper within the German psychiatric health care system, his/her role needs to be evaluated.
On the basis of the psychiatric documentation (DGPPN-BADO) of 4066 patients predictors for referral to inpatient psychiatric care by the general practitioner together with outpatient aftercare were analysed by means of logistic regression models.
18.4% of the patients were referred by a general practitioner, mostly those with an affective disorder (Odds Ratio 4.0) or schizophrenia (OR 3.3), and residents of old people's or nursing homes (OR 3.5). In 49.9% of the patients, aftercare by a general practitioner was recommended - more frequently patients with addictive disease (OR 2.0), pensioners (OR = 1.7) and elderly patients (OR 1.03), more rarely patients with schizophrenia (OR 0.4) or affective disorders (OR 0.7).
In view of the relatively low referral rate, in-hospital quality management should focus on improving cooperation between psychiatric hospital and GP.
鉴于全科医生在德国精神卫生保健系统中作为守门人的重要性日益增加,需要对其角色进行评估。
基于4066名患者的精神科文档(DGPPN-BADO),通过逻辑回归模型分析全科医生将患者转诊至住院精神科护理以及门诊后续护理的预测因素。
18.4%的患者由全科医生转诊,主要是患有情感障碍(优势比4.0)或精神分裂症(优势比3.3)的患者,以及养老院或疗养院的居民(优势比3.5)。在49.9%的患者中,建议由全科医生进行后续护理——成瘾性疾病患者(优势比2.0)、退休人员(优势比 = 1.7)和老年患者(优势比1.03)更频繁,精神分裂症患者(优势比0.4)或情感障碍患者(优势比0.7)则较少。
鉴于转诊率相对较低,医院质量管理应侧重于改善精神病医院与全科医生之间的合作。