Quality of Referrals Information from Primary Health Care to a Psychiatric Consultation

Abstract

Introduction: In Portugal, primary health care doctors are the main source of referral cases to secondary mental health services. The quality of referral may have consequences for the primary health care doctor, for the psychiatrist who will receive it, and especially to the referenced user.Objectives: To assess the quality of referral letters from primary health care units in Alentejo (ACES Alentejo Central) to a psychiatric outpatient service at the Hospital do Espirito Santo in Evora (HESE); to determine the prevalence of the psychiatric disorders identified as diagnostic hypotheses in the referral.Methods: Cross-sectional observational study. All referrals from December 2013 and May 2014 were included. Referral letters were analyzed in terms of structure, considering each of the fields defined in the Alert P1® platform and in terms of content, taking into account the referral criteria described by the World Health Organization (WHO). The prevalence of the psychiatric disorders identified as diagnostic hypotheses for referral were determined, using the criteria of the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5).Results: Of the 245 referrals analyzed, 220 were included in the study. Only 2.27% of referrals had all the eleven fields defined in the Alert P1® platform completed. 35% of referrals did not identify any criteria to justify the referral for psychiatry consultation. Treatment failure was the most frequent referral criterion, present in 30.91% of cases. Depressive and anxious disorders were the most referred to the psychiatric outpatient service.Conclusions: The results highlighted the importance of raising awareness amongst general practitioners, for a correct and complete filling-out of referral guide Alert P1® platform referral guide. It is imperative to define and implement referral criteria in Portugal to enable improved communication between primary and secondary Mental Health Care.