School of Psychology, University of Newcastle, Callaghan, Australia.
Aust N Z J Psychiatry. 2012 May;46(5):435-44. doi: 10.1177/0004867412440341. Epub 2012 Feb 24.
GPs have referred patients for psychological treatment under the Better Outcomes in Mental Health Care, Access to Allied Psychological Services (ATAPS) Program since 2003. It is not known how GPs might select patients for referral. We explored which characteristics identified ATAPS patients compared to usual GP patients.
The study was conducted in GP Access, a Division of General Practice (Newcastle and Lower Hunter) in NSW, Australia. It was a case-control design with 63 cases (ATAPS patients), and 64 controls (GP patients never referred to ATAPS). Unadjusted and sequentially adjusted logistic regressions were used to identify independent predictors of being an ATAPS case based on official referral guidelines: ICD-10 diagnosis of depression or anxiety and scores on the K-10 (psychological distress) and DASS-21 (psychological symptoms). A multivariable logistic regression was also used to determine the best minimum set of predictor variables.
Eight-three per cent of ATAPS cases had anxiety or depression. In unadjusted models, any mood disorder, OR 7.68 (95% CI: 3.47, 17.01), any anxiety disorder, OR 2.88 (95% CI: 1.37, 6.05), higher K-10 score, OR 1.06 (95% CI: 1.04, 1.14) and higher DASS-21 score, OR 1.06 (95% CI: 1.03, 1.09) were associated with being an ATAPS case. Any mood disorder, any anxiety disorder, K-10 score and DASS-21 scores remained significant in most adjusted analyses and all models showed change when adjusted for mental disability and physical disability. Three variables predicted being an ATAPS case in the multivariable regression: greater mental disability, lesser physical disability and greater number of substances misused.
Cases had higher levels of mental disability and greater substance misuse, but lower levels of physical disability. This may reflect GP referral decision making and have implications for policy development.
自 2003 年以来，全科医生一直在通过“改善精神卫生保健服务获取途径和辅助心理服务项目”（ATAPS）将患者转介至心理治疗。目前尚不清楚全科医生如何选择转介患者。我们探讨了哪些特征可以将 ATAPS 患者与一般的全科医生患者区分开来。
该研究在澳大利亚新南威尔士州纽卡斯尔和下亨特的普通科医生分部（GP Access）进行。采用病例对照设计，共纳入 63 例病例（ATAPS 患者）和 64 例对照（从未被转介至 ATAPS 的全科医生患者）。使用未经调整和逐步调整的逻辑回归，根据官方转诊指南，确定将患者识别为 ATAPS 病例的独立预测因素：ICD-10 诊断为抑郁或焦虑，以及 K-10（心理困扰）和 DASS-21（心理症状）的评分。还使用多变量逻辑回归确定最佳的最小预测变量集。
83%的 ATAPS 病例患有焦虑或抑郁。在未调整的模型中，任何心境障碍，OR7.68（95%CI：3.47，17.01），任何焦虑障碍，OR2.88（95%CI：1.37，6.05），较高的 K-10 评分，OR1.06（95%CI：1.04，1.14）和较高的 DASS-21 评分，OR1.06（95%CI：1.03，1.09）与成为 ATAPS 病例相关。在大多数调整后的分析中，任何心境障碍、任何焦虑障碍、K-10 评分和 DASS-21 评分仍然具有显著性，并且所有模型在调整精神残疾和身体残疾后均显示出变化。多变量回归中，有三个变量可预测成为 ATAPS 病例：更高的精神残疾程度、更低的身体残疾程度和更多的物质滥用。
病例组的精神残疾程度更高，物质滥用情况更严重，但身体残疾程度更低。这可能反映了全科医生的转诊决策，并对政策制定产生影响。
