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

摘要： 背景　精神心理障碍造成的危害逐年升高。全科门诊协作精神专科对精神心理障碍进行诊治管理被认为具有重要价值，其中转诊作为当前协作诊疗的重要策略和方法在临床实践中存在不足和困难，尤其是转诊途径利用的欠缺。而目前缺乏针对转诊欠佳的相关研究。目的　了解并分析全科医师对门诊精神心理障碍患者转诊情况及其影响因素，为转诊策略优化和途径有效利用提供依据。方法　2018年8月1—30日，采用分层随机抽样法，选取上海市杨浦区、黄浦区、普陀区、浦东新区和嘉定区的12家社区卫生服务中心/医院，根据纳入标准，从中选取全科医师203例为调查对象。采用自制调查问卷对其进行调查，内容包括：全科医师一般情况、门诊转诊情况、期望转诊形式。结果　共发放问卷203份，回收有效问卷190份，有效回收率为93.6%。190例全科医师中，有转诊行为29例（15.3%），曾让患者自行去精神科或心理科就诊138例（72.6%）；考虑会转诊的患者情况前3位分别为治疗有困难（143例，75.3%）、诊断不明确（141例，74.2%）、初次发现有精神问题或症状（131例，68.9%）；认为转诊的难度为一般困难85例（44.7%）；认为影响转诊的因素前3位分别为自己对于病情的判断缺乏把握（149例，79.3%）、与转诊的精神心理专科医师或机构缺乏联系（104例，55.3%）、患者或家属依从性差（90例，47.9%）；转诊途径主要为网上转诊平台65例（60.2%）；了解转诊途径55例（28.9%）；认为转诊途径实用93例（48.9%）；清楚全科门诊对转诊的政策支持83例（43.7%）；认为有义务转诊170例（89.5%）；所在全科门诊精神类药物种类情况以一般齐全〔73例（38.4%）〕为主。多因素Logistic回归分析结果显示，了解转诊途径情况、认为转诊途径实用情况是全科医师转诊行为影响因素（P<0.05）。190例全科医师中，67.4%（128例）期望开通转诊通道，53.7%（102例）期望专家坐诊，52.1%（99例）期望与专科医师开通联合门诊。结论　当前全科医师在门诊工作中对于精神心理障碍患者有较大转诊需求，但相关转诊行为有所欠缺，其认为造成转诊困难的因素包括其主观上对精神心理障碍的诊治困难和处理信心不足，以及客观上缺乏转诊途径和患者依从性差，而影响其转诊行为的因素为了解转诊途径情况、认为转诊途径实用情况。

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