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What drives referral from primary care physicians to mental health specialists? A randomized trial using actors portraying depressive symptoms.

Abstract：

BACKGROUND:Referral from primary care to the mental health specialty sector is important but poorly understood. OBJECTIVE:Identify physician characteristics influencing mental health referral. DESIGN:Randomized controlled trial using Standardized Patients (SPs). SETTING:Offices of primary care physicians in 3 cities. PARTICIPANTS:One hundred fifty-two family physicians and general internists recruited from 4 broad practice settings; 18 middle aged Caucasian female actors. INTERVENTION:Two hundred and ninety-eight unannounced SP visits, with assignments constrained so physicians saw 1 SP with major depression and 1 with adjustment disorder. MEASUREMENTS:Mental health referrals via SP written reports; physician and system characteristics through a self-administered physician questionnaire. RESULTS:Among 298 SP visits, 107 (36%) resulted in mental health referral. Referrals were less likely among physicians with greater self-confidence in their ability to manage antidepressant therapy (adjusted odds ratio [AOR] 0.39, 95% confidence interval [CI] 0.17 to 0.86) and were more likely if physicians typically spent > or =10% of professional time on nonclinical activities (AOR 3.42, 95% CI 1.45 to 8.07), had personal life experience with psychotherapy for depression (AOR 2.74, 95% CI 1.15 to 6.52), or usually had access to mental health consultation within 2 weeks (AOR 2.94, 95% CI 1.26 to 6.92). LIMITATION:The roles portrayed by SPs may not reflect the experience of a typical panel of primary care patients. CONCLUSIONS:Controlling for patient and health system factors, physicians' therapeutic confidence and personal experience were important influences on mental health referral. Research is needed to determine if addressing these factors can facilitate more appropriate care.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Kravitz RL,Franks P,Feldman M,Meredith LS,Hinton L,Franz C,Duberstein P,Epstein RM

doi

10.1111/j.1525-1497.2006.00411.x

subject

Has Abstract

pub_date

2006-06-01 00:00:00

pages

584-9

issue

eissn

0884-8734

issn

1525-1497

pii

JGI411

journal_volume

pub_type

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What drives referral from primary care physicians to mental health specialists? A randomized trial using actors portraying depressive symptoms.