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[How do we refer to mental health from primary care?]
I Miranda Chueca1, M T Peñarrubia María, I García Bayo
1Especialistas en Medicina Familia y Comunitaria. ABS Gavà II. Institut Català de la Salut. DAP Baix Llobregat Litoral. Unitat Docent Costa de Ponent. Barcelona. España.
Objectives:
To describe referrals from primary care (PC) to mental health (MH) and to study the diagnostic and therapeutic concordance between the two.
Design:
Retrospective, descriptive study.
Setting:
Gavà II Primary Care Centre, Barcelona.Participants. All patients referred to MH in 1998, 1999 and 2000 (n=380).
Main Measurements:
The following from the referral form and PC medical records were analysed: general diagnosis, drugs treatment, number of words in the report, and purpose of referral; and on the first visit to MH: general diagnosis and drugs treatment. The kappa index was used to analyse the concordance between the diagnostic and therapeutic groups.
Results:
There were 380 referrals, 63.4% of which were women. Information was obtained from the referral form in 81.6% of cases. In 50.7% the reason for referral was for the case to be supervised; and in 12.4% the reason was not recorded. 18.7% (71 cases) did not attend their first MH appointment and waited an average of 78 days (SD=70.9) until the appointment. As 92 cases were lost (71 who did not attend and 21 for whom insufficient information was obtained), only 288 cases were analysed.The greatest diagnostic concordance between PC and MH was in mental deficiency (kappa=0.85) and psychotic disorder (kappa=0.77); and the minimum was in anxiety-depressive disorder (kappa=0.24). The maximum degree of therapeutic concordance was for neuroleptic drugs (kappa=0.66).
Conclusions:
The diagnostic and therapeutic concordance between PC and MH is weak. The referral sheet is not present in a great many cases. The waiting-time until the first consultation may explain patient absenteeism.