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Abstract
Background. In Norway, general practitioners serve as gatekeepers for specialist psychiatric care. Out-of-hours primary healthcare (i.e. casualty clinics) is responsible for the major part of acute psychiatric referrals. There are concerns regarding regular general practitioners’ (rGPs’) role in emergency psychiatric care of their enlisted patients. Also, the quality of casualty clinics’ care and their gatekeeper function are questioned. Aims. To investigate differences between acute admissions to a psychiatric hospital from casualty clinics, rGPs, specialist psychiatric services and other specialist services regarding characteristics of patients and circumstances of the referrals. Methods. A prospective observational study. In the period of 1 May 2005 to 30 April 2008, anonymous information was recorded for all consecutive admissions (n = 5317) to the psychiatric acute unit (PAU) at a psychiatric hospital serving 400,000 inhabitants. The recorded information was: referring agent, circumstances of the referral, patient characteristics, and assessments by the receiving psychiatric resident and the therapist in charge of treatment at the PAU. Results. There were only small differences between patients referred to PAU from casualty clinics, rGPs, specialist psychiatric services and other specialist services. The referrals from the different referring agents seemed equally well founded. However, the casualty clinics used more police assistance and coercion, and legal basis for admissions was more frequently converted than for other referring agents. Conclusion. Casualty clinics seem to function adequately as gatekeepers. The high proportion of casualty clinic referrals with converted legal basis might indicate unnecessary use of coercion.
Acknowledgement
This work was supported by the National Centre for Emergency Primary Health Care, Uni Health, Bergen and the Division of Psychiatry, Haukeland University Hospital, Bergen, Norway. The first author had a research grant from Norwegian Medical Association's Funds for Research in General Practice. The second author had a research grant from the Western Norway Regional Health Authority. The authors thank Geirr Fitje, BBA, for his contribution to the high quality of the data.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.