关键词: 情感障碍, 精神病性；门诊病人；全科医生；病人转诊；影响因素分析

Abstract: Background　As psychological disorder has caused more and more problems in the society，the cooperative management of its diagnosis and treatment by psychiatric specialists in the general clinic is considered of great value.The referral process，as an important strategy and method for current collaborative diagnosis and treatment，is deficient and difficult to perform in clinical practice，especially for the utilization of referral routes.At present，studies about this issue are lacking.Objective　To understand and analyze the referrals of outpatients with psychological disorders by general practitioners（GPs）and its influencing factors to address the basis for the strategic optimization and the effective referral usage.Methods　A total of 12 community health service centers/hospitals in Yangpu District，Huangpu District，Putuo District，Pudong New Area，and Jiading District in Shanghai were included by stratified random sampling from August 1st to 30th 2018.According to the inclusion and exclusion criteria，203 general practitioners were selected.A self-designed questionnaire，including GP's demographic characteristics，out-patient referrals，and expected referrals，was used in this study.Results　A total of 190 valid questionnaires out of 203 sent questionnaires were collected with an effective recovery rate of 93.6%.Among 190 GPs，138 of them（72.6%）have suggested their patients to the psychiatric department，only 29 GPs（15.3%）have actually referred their patients.The top 3 situations that GPs consider a referral included difficulties in treatment（143 subjects，75.3%），unclear diagnosis（141 subjects，74.2%），and the primary diagnosis of mental problems or symptoms（131 subjects，68.9%）．Eighty-five subjects（44.7%）had experienced difficulties in referrals.The top three factors that influenced referrals were GPs' lacking of diagnostic assurance（149 subjects，79.3%），lacking of connections with the referred psychiatric specialists or institutions（104 subjects，55.3%），and poor compliance of patients or family members（90 subjects，47.9%）．Sixty-five subjects（60.2%）considered the referral route as the online referral platform；55 subjects（28.9%）understood the referral approaches；93 subjects（48.9%）thought that referrals were practical.83 subjects（43.7%）were aware of the supportive policy in general outpatient clinics；and 170 subjects（89.5%）considered that they were obligated to make referrals.Additionally，73 subjects（38.4%）believed that the key types of psychoactive drugs in their general clinics were generally adequate.Results of multivariate Logistic regression analysis showed that understanding the approach of referral，and the referrals' practical usage were key influencing factors（P<0.05）．Of 190 general practitioners，67.4%（128 cases）expected to have referral channels，53.7%（102 cases）expected expert consultation，and 52.1%（99 cases）expected to have joint clinics with specialists.Conclusion　A great demand for the referral of patients with psychological disorders in the current general clinics cannot be neglected.However，the actual referral is insufficient.Factors causing the difficulty of referrals are the difficulties and lack of confidence of diagnosis and treatment for psychological disorders，the lack of referral approaches，and poor compliance of patients.The actual referrals are determined by the understanding of the referrals ways，and the practical usage of referrals.

Key words: Affective disorders, psychotic；Outpatients；General practitioners；Patient transfer；Root cause analysis