Abstract: Background　The incidence of mental illness is increasing，and the cost of curing psychological disorders is burdensome，which sets a higher requirement for today's health service system and mode.The collaborative clinic system of general practitioners（GPs） and psychiatrists is of great value for the diagnosis and treatment of psychological disorders，but the current collaboration in China does not work quite satisfactorily.Objective　To discover and analyze the obstacles of the collaborative clinic system of GPs and psychiatrists with the purpose to optimize the collaborative strategies.Methods　A total of 20 GPs and 30 patients with mental disorders or their families from one general hospital（H1），two urban community hospitals（H2，H3） and one suburban community hospital（H4），and 10 psychiatrists from the same areas were randomly selected for the investigation and interviews from August 1st to September 30th in 2018.The interview covered five main aspects of interviewee's cognition，behavior，attitude，questions and opinions related to collaborative diagnosis and treatment system.The interview duration was about half an hour and it was recorded.The recording was transcribed electronically.First，each question was coded at the first level.Then，the corresponding content of each encoding was discussed and condensed to generate the descriptive label for further data induction and classification.Then the subjects were generated by classification，and representative interview speeches were cited by the respondents.Results　（1）GPs had a certain cognition of the collaborative diagnosis and treatment，but the current collaboration with psychiatrists did not work quite well.GPs thought that collaboration was of great significance，but it still faced multiple difficulties involving channels，resources，doctors and patients.GPs suggested that collaboration could be promoted with varied forms including collaborative resources and forms，and improving GPs' own expertise.（2）The psychiatrists carried out collaborative diagnosis and treatments in community，including community clinics，but they thought that the effects of collaboration were different.They thought the collaboration was necessary and beneficial to patients' physical and mental health，as well as their family and social problems.However，psychiatrists also mentioned that there were various problems and difficulties in the current collaboration from aspects of allocation of resources and patients.They advised that collaboration required more mutual learning and communication，expanded publicity and platform construction.（3）The patients or their family members had little cognition of collaboration，and they agreed with collaboration but lack of active suggestions.Most of patients had not accepted the collaborative diagnosis and treatment and many of them were sent to different medical institutions without standard treatments.The patients mainly relied on psychiatric drugs without suitable prescriptions.There was a need for collaborative clinic system in community，but patients distrusted the GPs.There were also other problems such as the lack of psychiatric drugs，or small prescriptions in community clinics.Conclusion　At present，there are problems and obstacles in the collaboration clinic system between GPs and psychiatrists in the diagnosis and treatment of patients with mental disorders，including the incoordinate information and resources between doctors and patients，and lack of effective implementation of collaboration platforms and strategies.The optimization strategies include improving the ability of GP to diagnose and treat mental disorders，improving the collaboration modes and channels，and implementing and utilizing the existing collaboration platforms and resources.Policy encouragement and patient education should also be strengthened.

Key words: Mental disorders；Affective disorders, psychotic；General practitioners；Hospitals, Special

摘要： 背景　随着精神心理疾病的发病率升高、疾病负担增大，对当今卫生服务体系和模式提出了更高要求。全科与精神心理专科协作诊治门诊精神心理障碍具有重要价值，但当前国内的协作现况不佳。目的　了解并分析当前全科与精神心理专科协作诊治门诊精神心理障碍患者的专科协作障碍，探索优化策略。方法　2018-08-01至2018-09-30选取上海市1家综合性医院（H1）、2家市区社区医院（H2、H3）、1家郊区社区医院（H4）的全科医师（n=20），以及所处区域精神心理科医师（n=10）和就诊于全科门诊的精神心理障碍患者或其家属（n=30）进行访谈调查。访谈领域覆盖调查对象对于协作诊疗相关的认知、行为、态度、问题、意见5个方面，访谈持续时间为0.5 h左右，并录音记录，对录音进行电子文档转录，首先对各个问题进行第一层编码，然后对编码对应的内容进行讨论、浓缩，生成描述性标签，做进一步数据归纳和分类，进而生成主题，并选取有代表性的访谈发言作为受访者引用。结果　（1）全科医师对协作诊疗内容具有一定认知，但是目前与精神心理专科的协作现况不佳；认为协作具有较多意义，但面临包括渠道、资源及医师和患者等困难；全科医师给出了包括协作资源、形式方面和提高医师自身专业知识的促进协作的建议。（2）精神心理科医师知晓并开展包括到社区坐诊等与社区的协作诊疗，但认为开展效果各异；认为协作很有必要，有益于处理患者的身心和家庭社会问题；精神心理科医师也提到当前协作存在着包括患者方面和社区资源配置的各种问题和困难；精神心理科医师提出协作需要更多相互学习交流、扩大宣传、平台建设等支持策略。（3）患者或其家属对协作认知少，认为可以有协作，但缺乏主动建议；大部分未接受协作诊疗，往返于多处医疗机构，治疗不规范；较依赖精神科药物，但用药不规范；对协作中社区诊治方面比较有需求，但目前存在诸如不信任全科医师、社区精神科药物缺乏或处方量小等问题。结论　当前全科与精神心理专科协作诊治门诊精神心理障碍患者存在医患各方信息和资源不对等、协作平台和策略未能有效落实等问题与障碍。优化策略包括：提高全科医师诊治精神心理疾病的水平；改进协作模式和渠道；落实和利用现有协作相关平台资源。其中还需注意政策鼓励和患者方面宣教。

关键词: 精神障碍；情感障碍, 精神病性；全科医生；医院, 专科；多方访谈