Harold Alan Pincus, M.D., American Psychiatric Association, Washington, D.C.; Deborah A. Zarin, M.D.; Terri L. Tanielian, M.A.; Allen Dietrich, M.D.; John Williams, M.D.; Paul Nutting, M.D.; Tom Oxman, M.D.; Roger Kathol, M.D.

Purpose: To better understand the nature of the mental health referral process through characterizing the current communication and referral interface between psychiatry and primary care.

Methods: The American Psychiatric Association Practice Research Network (PRN) is developing a two-phase study to examine the current referral and communication process between primary care and psychiatry. Using a 10-item mail survey, Phase I gathered data from psychiatrists regarding the frequency of referrals from primary care and the nature and frequency of and satisfaction with their communication between primary care physicians. Phase II will gather detailed patient-level data on 4 new outpatients per psychiatrist to examine the mechanics of the referral process and assess the types, frequency, and satisfaction with communication with primary care physicians. This 30-item paper/pencil survey also collects psychiatrist-reported data regarding the patient's demographic, clinical, treatment, and system/setting characteristics.

Results: To date, over 80% of PRN members have completed the Phase I survey. Follow up efforts are underway to ensure a complete response. Phase II is scheduled to be implemented in May 1998. Preliminary analysis of the Phase I date (n=231 psychiatrists) shows that 46% of psychiatrists indicated that the overall quality of their interactions with non-psychiatric physicians was fair or poor. 35% indicated that they actively seek referrals from non-psychiatric physicians. With regard to the type of information communicated to psychiatrists by non-psychiatric physicians, 48.3% of indicated that they often or always receive the information regarding the reason for the referral. However, 38.6% of psychiatrists indicated they almost never or never receive the patient's treatment history. 78% of psychiatrists reported that they often or always provide diagnostic information and treatment information regarding the patient back to the referring non-psychiatric physician, but 26% of psychiatrists report confidentiality concerns often or sometimes limit them from sharing this information. Data will also be compared to similar data being collected through the Ambulatory Sentinel Practice Network (ASPN) Referral Study in family medicine and other studies.

Conclusions: Results from these surveys will be used to help build a conceptual framework of the various domains and aspects of the referrals for mental health patients. Through collaboration with primary care and psychiatric researchers, this initiative will develop a multi-disciplinary project to implement and evaluate an intervention based on this framework and aimed at improving the referral process and enhancing the communication interface between psychiatry and primary care.

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