Verhaak P F
Netherlands Institute of Primary Health Care, Utrecht.
Br J Gen Pract. 1993 May;43(370):203-8.
The majority of people in the community who have a psychiatric disorder will consult their general practitioner. Referrals from general practice to specialist services are, however, relatively rare. The filter between primary care and specialist care has been characterized by Goldberg and Huxley as the least permeable of the filters separating psychiatrists and other specialists from the populations they serve. These referrals form the subject of this study in the Netherlands. Using a large database of doctor-patient contacts, the proportion of mental health disorders resulting in a referral and the characteristics of the patient and general practitioner that are involved in such a referral have been determined. In addition, the type of mental health institution or specialist to which referrals were directed and the characteristics influencing this choice were examined. Only 6% of patients presenting with a psychiatric disorder during surgery hours were referred to specialist care. Younger patients, male patients and patients with severe diagnoses had a greater probability of being referred. The percentage of patients referred was higher in urban areas than in rural areas. Doctors with a limited task perception regarding mental treatment tended to refer more often. Although the diagnosis did have some relationship with the institutions to which patients were referred (psychotic conditions to psychiatric services and social/material problems to social workers), the most prevalent diagnoses (neurotic conditions and relationship problems) seemed to be more or less randomly distributed over the various possibilities. Preferences appeared to be related to the existence of regular meetings between general practitioners and specialists and a positive evaluation by general practitioners of the institution concerned.
社区中患有精神疾病的大多数人会咨询他们的全科医生。然而，从全科医疗转诊到专科服务的情况相对较少。初级保健和专科护理之间的筛选环节，被戈德堡和赫胥黎描述为将精神科医生和其他专科医生与其所服务人群分隔开来的筛选环节中渗透性最差的。这些转诊构成了荷兰这项研究的主题。利用一个庞大的医患接触数据库，已确定导致转诊的精神健康障碍比例以及涉及此类转诊的患者和全科医生的特征。此外，还研究了转诊所指向的精神健康机构或专科医生的类型以及影响这一选择的特征。在手术时间出现精神疾病的患者中，只有6%被转诊至专科护理。年轻患者、男性患者和诊断严重的患者被转诊的可能性更大。城市地区被转诊患者的比例高于农村地区。对心理治疗任务认知有限的医生往往更频繁地进行转诊。尽管诊断与患者被转诊至的机构确实存在一定关系（精神病性状况转诊至精神科服务，社会/物质问题转诊至社会工作者），但最常见的诊断（神经症性状况和人际关系问题）似乎或多或少随机分布在各种可能性中。偏好似乎与全科医生和专科医生之间定期会议的存在以及全科医生对相关机构的积极评价有关。
