Background. The gatekeeper function of the general practitioner
(GP) in the pathway to specialized
psychiatric services was investigated in this study, which is part of the
Nordic
Comparative Study on Sectorized Psychiatry. The question addressed in this
paper is whether different sociodemographic and clinical factors as well
as factors related to service utilization are associated with
referral from the GP compared with self-referrals (including referrals
from relatives).
Methods. The study comprised a total of 1413 consecutive patients,
admitted during 1 year to five
psychiatric centres in four Nordic countries. The centres included in this
study were those that accepted non-medical referrals. Only new patients
(not in contact with the service for at least 18 months) were included.
Results. Increasing age was the only sociodemographic factor
significantly associated with referral
by the GP. The clinical factors (psychosis, being totally new to
psychiatry and being in need of in-patient treatment) and some treatment
characteristics (planned out-patient treatment and
involuntary in-patient treatment), were all significantly associated with
referral by the GP. Some
indication was found that self-referred patients have shorter episodes
of care.
Conclusions. The findings were remarkably stable across the
different centres indicating a general
pattern. This study extends previous work on the role of GPs in the pathway
to specialized
psychiatric services and indicates that the GP has an important gatekeeper
function for the most disabled patients.