Sibbald B, Addington-Hall J, Brenneman D, Freeling P
Division of General Practice and Primary Care, St George's Hospital Medical School, London.
BMJ. 1993 Jan 2;306(6869):29-33. doi: 10.1136/bmj.306.6869.29.
To establish the prevalence of counselling services in English and Welsh general practices and factors associated with their distribution; to describe qualifications, working arrangements, and case mix of "counsellors."
Postal questionnaire and telephone interview survey of a sample of about one in 20 general practitioners in England and Wales.
English and Welsh general practices.
1880 general practitioners of whom 1542 (82%) completed questionnaires.
Prevalence and distribution of practice counselling services; counsellors' qualifications and funding; types of patients referred.
586 counsellors were distributed among 484 of the 1542 practices. Three types of counsellor predominated: community psychiatric nurses (187); "practice counsellors" (145); and clinical psychologists (95). Practice characteristics which independently predicted the presence of a counsellor were for community psychiatric nurses four or more partners (odds = 1.72, 95% confidence interval 1.18 to 2.26); for practice counsellors stress clinic (odds = 2.22; 1.83 to 2.61), training practice (odds = 1.70; 1.24 to 2.16), and health region (chi 2 = 55.94; df = 14; p < 0.001); and for clinical psychologists list size of > or = 10,500 (odds = 1.79; 1.09 to 2.49), training practice (odds = 1.78; 1.31 to 2.25), health region (chi 2 = 48.31; df = 14; p < 0.001). 197 counsellors had training in counselling. The qualifications of 85 were unknown to the general practitioner. The principal source of funding was the district health authority for community psychiatric nurses (150) and clinical psychologists (58) and the family health services authority for practice counsellors (76). All counsellors were referred a wide range of problems.
Counselling services are wide-spread in general practice, but a high proportion of counsellors lack qualifications, and many may be referred problems outside their knowledge.
确定在英格兰和威尔士的全科医疗中咨询服务的普及率及其分布的相关因素；描述“咨询师”的资质、工作安排及病例组合情况。
对英格兰和威尔士约二十分之一的全科医生样本进行邮寄问卷调查和电话访谈。
英格兰和威尔士的全科医疗。
1880名全科医生，其中1542名（82%）完成了问卷。
全科医疗咨询服务的普及率和分布情况；咨询师的资质和资金来源；转诊患者的类型。
在1542家全科医疗中，有484家配备了586名咨询师。三种类型的咨询师占主导：社区精神科护士（187名）；“全科医疗咨询师”（145名）；临床心理学家（95名）。能独立预测咨询师配备情况的全科医疗特征为：对于社区精神科护士，有四名或更多合伙人（比值 = 1.72，95%置信区间1.18至2.26）；对于全科医疗咨询师，有压力诊所（比值 = 2.22；1.83至2.61）、培训诊所（比值 = 1.70；1.24至2.16）以及健康区域（卡方 = 55.94；自由度 = 14；p < 0.001）；对于临床心理学家，名单规模≥10500（比值 = 1.79；1.09至2.49）、培训诊所（比值 = 1.78；1.31至2.25）以及健康区域（卡方 = 48.31；自由度 = 14；p < 0.001）。197名咨询师接受过咨询培训。85名咨询师的资质全科医生并不知晓。资金主要来源为地区卫生局（用于社区精神科护士150名、临床心理学家58名）以及家庭健康服务局（用于全科医疗咨询师76名）。所有咨询师都会接到各种各样的转诊问题。
咨询服务在全科医疗中广泛存在，但很大一部分咨询师缺乏资质，而且许多人可能会接到超出其知识范围的问题。
