Strain J J, Gise L H, Fulop G, Strain J J, Hammer J S
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029.
Gen Hosp Psychiatry. 1991 Mar;13(2):88-94. doi: 10.1016/0163-8343(91)90019-s.
Despite their importance, the nature and context of referral patterns among mental health disciplines in the general hospital has not been sufficiently explored. This study focuses on consultation-liaison (C-L) psychiatry patterns of referral to social work services (SWS). From a structured data base of 1170 consults, it was observed that C-L referred 24% of the cases seen by psychiatry. Psychiatry was more likely to refer those who are: female (p = less than 0.05), living with others (p = less than 0.05), described as less urgent (p = less than 0.05), diagnosed with personality disorders (p = less than 0.01), under greater psychosocial stress (Axis IV) (p = less than 0.001), and evaluated as having better functional status (Axis V) (p = less than 0.001). Regression analysis revealed that four variables had the greatest impact on differentiating those C-L referred to SWS from the "others": 1) constant observation recommended (log -586, p = 0.0001); 2) type of psychiatric management (log -573, p = 0.0001); 3) Medicaid insurance (log -564, p = 0.0001); and 4) original referral for the consultation was the refusal of tests or medical treatment (log -559, p = 0.002).
尽管其重要性，但综合医院心理健康学科之间转诊模式的性质和背景尚未得到充分探讨。本研究聚焦于精神科联络会诊（C-L）至社会工作服务（SWS）的转诊模式。从1170例会诊的结构化数据库中观察到，C-L转诊了精神科所诊治病例的24%。精神科更有可能转诊以下人群：女性（p<0.05）、与他人同住（p<0.05）、被描述为不太紧急（p<0.05）、被诊断为患有个性障碍（p<0.01）、处于更大心理社会压力下（轴IV）（p<0.001）以及被评估为功能状态较好（轴V）（p<0.001）。回归分析显示，有四个变量对区分那些被C-L转诊至SWS的患者与“其他患者”影响最大：1）建议持续观察（对数-586，p = 0.0001）；2）精神科管理类型（对数-573，p = 0.0001）；3）医疗补助保险（对数-564，p = 0.0001）；4）会诊的最初转诊原因是拒绝检查或治疗（对数-559，p = 0.002）。
