Referral gridlock: Primary care physicians and mental health services

Patients' barriers to mental health services are well documented and include social stigma, lack of adequate insurance coverage, and underdiagnosis by primary care physicians. Little is known, however, about challenges primary care physicians face arranging mental health referrals and hospitali...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2003-06, Vol.18 (6), p.442-449
Main Authors: TRUDE, Sally, STODDARD, Jeffrey J
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cross-Sectional Studies
Family Practice
Female
Gatekeeping - standards
Gatekeeping - statistics & numerical data
General aspects
Health Care Surveys
Health Services Accessibility
Hospitals, Psychiatric - standards
Hospitals, Psychiatric - statistics & numerical data
Humans
Longitudinal Studies
Male
Medical sciences
Mental Health Services - standards
Mental Health Services - statistics & numerical data
Original
Planification. Prevention (methods). Intervention. Evaluation
Primary Health Care
Public health. Hygiene
Public health. Hygiene-occupational medicine
Referral and Consultation - standards
Referral and Consultation - statistics & numerical data
United States
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Summary:Patients' barriers to mental health services are well documented and include social stigma, lack of adequate insurance coverage, and underdiagnosis by primary care physicians. Little is known, however, about challenges primary care physicians face arranging mental health referrals and hospitalizations. To examine how practice setting and environment influence primary care physicians' ability to refer patients for medically necessary mental health services. Cross-sectional analysis using nationally representative survey data from the 1998 to 1999 Community Tracking Study physician survey. The overall survey response rate was 61%. A 1998 to 1999 telephone survey of 6586 primary care physicians. Primary care physicians' report of whether they could obtain medically necessary referrals to high-quality mental health specialists or psychiatric admissions. Overall, 54% of primary care physicians reported problems obtaining psychiatric hospital admissions, and 54% reported problems arranging outpatient mental health referrals. Primary care physicians practicing in staff and group model HMOs were much less apt to report difficulties than physicians in solo and small-group practices (P
ISSN:0884-8734
1525-1497
DOI:10.1046/j.1525-1497.2003.30216.x