IS DE HUISARTS POORTWACHTER IN DE GEESTELIJKE GEZONDHEIDSZORG?

Introduction: In recent decades, a steady increase in referrals to the psychiatry has taken place. This was not the intention of the government policy, which aimed for more referrals to the psychologist instead of the psychiatry to keep the costs of healthcare manageable. In health center Lewenborg (GCL), where eight GPs are active, there was also an increase in the number of referrals to the psychiatry despite stimulation of referring to the psychologist. The GPs wanted more insight into their referral behavior, which led to this scientific study. The following research questions were formulated: 1.How many and which psychological problems are referred to the psychiatry and which to a psychologist? 2.Do GPs differ in their referral policy? 3.Have there been changes in the last three years? Method: From the GP information system (HIS), the written referrals to mental health care (psychiatry) and primary care psychologists were collected and made anonymous. Referrals from patients aged 18-65 years in the period 2008 to January 1, 2011, were included. We created a database in which gender, age, year of referral, referral address, referring physician, referral diagnosis and aim of referral were recorded. Descriptive statistics were used. The chi-square, t-test and variance analysis were applied to determine significant differences. Results: In total, 1050 written referrals were analyzed. The number of referrals to the mental health care as well as to the psychologist increased over the course of three year. Proportionally there was a shift in these three years. In 2008 many patients were referred to the psychiatry, while in 2010 many patients were referred to the psychologist. Depression was the diagnosis for which most patients were referred to the psychiatry, followed by assessments for ADD / ADHD. Men, younger patients and patients with severe psychological problems were referred more often to the psychiatry. Women, elderly patients and patients with distress or social problems are mainly referred to the psychologist. There is inter-physician variance in both the number of referrals to the psychologist and the mental health care and the nature of the referred diagnoses. During the course of three years, there was no change in the pattern of referral diagnoses. The increase in referrals is not due to an increase of a specific disease. Discussion and conclusion: Stimulation of referring patients to the psychologist instead of referring them to the psychiatry has had its desired effect in the GCL. However, this effect was overlooked by the increase of the total number of referrals. Which was not attributable to an increase in referrals from a specific diagnosis or a change in the referring behavior of individual physicians. A complex of physician-related and social factors caused the increase in the number of referrals. By making GP aware of their referral behavior by means of feedback and group discussions, a reduction in the number of referrals can be accomplished. Research into the effect of such interventions is necessary to prove this.