Communication between general practitioners and psychiatrists

Fitzmaurice, D; Krishnan, V. H. R.; Oyebode, Femi

doi:10.1192/pb.16.8.468

Cited by 16 publications

(7 citation statements)

References 4 publications

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“…Prasher et al (1992) showed that 68% of GPs listed medication on referral of 270 people to out patient departments, while 95% of psychiatrists listed drugs in their reply-drug records were not compared.…”

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What the eye doesn't see: drugs psychiatrists and GPs don't know their patients are on

Clarke¹

1993

Psychiatr. bull.

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Personal experience shows that discrepancies are common when out-patient psychiatric medication records are checked with the information held by a patient's GP. This could lead to duplicated or con flicting treatment regimes, dangerous drug inter actions, abuse of prescribed drugs, and failure to monitor therapeutic drug levels.This study compares the information held by psychiatrists and GPs about psychiatric out patients' consumption of prescribed and unprescribed medication; this information was used to examine the efficacy of communication about these drugs. Prasher et al (1992) showed that 68% of GPs listed medication on referral of 270 people to out patient departments, while 95% of psychiatrists listed drugs in their reply-drug records were not compared. The studyA single psychiatric out-patient clinic session for 20 patients was selected, at Barnet, Hertfordshire, a London suburb with a population of 200 000. The records were examined of 16 patients being seen at repeat appointments, of three being seen after rereferral 'de novo', and of one patient who did not attend. There were no completely new patients.Out-patient and general practice medication re cords and letters were audited for the preceding six months.Drug information from the hand-written out patient notes, pharmacy cards (available for 14of the patients), original GP letter (if any), and the copies of letters sent to the patient's GP were compared with GP medication records for the same patient. The latter items were obtained by telephone and in one case an additional letter to the patient's GP. Every patient's GP or GP partner was contacted; medication details of ten patients were held by the GP on computer. All references to prescribed or unprescribed drugs, with most recent dosage, and entries of 'no medi cation' were noted. Changes to medication that session were not included.

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confidence: 99%

What the eye doesn't see: drugs psychiatrists and GPs don't know their patients are on

Clarke¹

1993

Psychiatr. bull.

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“…A recent study showed that such information is contained in approximately 50% of referrals except for 'reason for referral', which is contained in 87Yn (Prasher et al, 1992). Old age psychiatrists may expect different information from GPs to reflect the increased incidence of physical illness and cognitive impairment in elderly compared to adult patients.…”

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confidence: 95%

“…There is some evidence of a link between the appropriateness of referral and the quality of infomation contained in the referral letter (Jenkins, 1993). Several studies exist examining the quality of referrals between GPs and adult psychiatrists (Pullen and Yellowlees, 1985;Wilkinson, 1989;Prasher et al, 1992) and between GPs and child psychiatrists (Kentish et ul., 1987;Cornwall, 1993) but no study has systematically looked at the quality of information in GP referrals to old age psychiatrists.There are studies which look at what hospital specialists in general expect from GP referrals (Newton et al, 1992) and for adult psychiatric patients (less than 65 years old) it has been suggested that referrals should contain information on reason for referral, main symptoms, past psychiatric history, medication and family history (Pullen and Yellowlees, 1985). A recent study showed that such information is contained in approximately 50% of referrals except for 'reason for referral', which is contained in 87Yn (Prasher et al, 1992).…”

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Referrals from general practitioners to old age psychiatrists

Brown¹,

Trotter²

1994

Int J Geriat Psychiatry

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SUMMARYA retrospective audit of 209 consecutive general practitioner referrals to an old age psychiatry service was performed to examine the quality of information available at the time of assessment, the diagnostic agreement and the differences between letter and telephone referrals. The information in telephone referrals was less complete, particularly for details of medical history, physical examination and investigations. However, diagnostic agreement was better for telephone than letter referrals. Overall use of cognitive function testing was low and was associated with misdiagnosis between functional and organic illness. In addition, a substantial number of cases of depressive illness were misdiagnosed as anxiety disorders or other functional illnesses. Our study suggests the need for clearer guidelines for referral procedures and continuing efforts to improve communication between general practitioners and old age psychiatrists. KEY WORDS-General practitioners, old age psychiatrists, communication, referralsIncreasing interest in audit and issues of quality has led to a greater focus on referrals between general practitioners (GPs) and hospital specialists. There is some evidence of a link between the appropriateness of referral and the quality of infomation contained in the referral letter (Jenkins, 1993). Several studies exist examining the quality of referrals between GPs and adult psychiatrists (Pullen and Yellowlees, 1985;Wilkinson, 1989;Prasher et al., 1992) and between GPs and child psychiatrists (Kentish et ul., 1987;Cornwall, 1993) but no study has systematically looked at the quality of information in GP referrals to old age psychiatrists.There are studies which look at what hospital specialists in general expect from GP referrals (Newton et al., 1992) and for adult psychiatric patients (less than 65 years old) it has been suggested that referrals should contain information on reason for referral, main symptoms, past psychiatric history, medication and family history (Pullen and Yellowlees, 1985). A recent study showed that such information is contained in approximately 50% of referrals except for 'reason for referral', which is contained in 87Yn (Prasher et al., 1992). Old age psychiatrists may expect different information from GPs to reflect the increased incidence of physical illness and cognitive impairment in elderly compared to adult patients.Traditionally, psychogeriatric teams have developed a style of service with home assessments for new referrals and the consultant as team leader. Many patients are referred by telephone and seen by consultants (Arie and Jolley, 1982;Jolley and Arie, 1992); this is in contrast to adult psychiatric service, where the majority of referrals are seen in outpatient clinics, are made by a traditional referral letter and are often seen by a member of the multidisciplinary team.This study aims to examine the quality of information available to old age psychiatrists at the time of assessment, whether this differs in telephone referrals compared to traditional le...

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“…This is particularly so if there is a question of psychotherapy, cognitive-behavioural therapy, other psychological therapies or, especially, counselling. Prasher et al (1992), studying communication between GPs and psychiatrists, found that GPs prefer letters from psychiatrists that are one page in length and have only two or three subheadings, but psychiatrists appear to prefer to write longer letters which follow the Institute of Psychiatry guidelines. Psychiatrists' letters varied from a minimum of A4 length to a maximum of three sides of A4.…”

Section: Communication Between General Practitioners and Psychiatristsmentioning

confidence: 99%

What a general practitioner can expect from a consultant psychiatrist

Wright¹

1997

Adv. psychiatr. treat

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There are many similarities in the experience and approach of general practitioners (GPs) and psychiatrists. GPs may spend some time in psychiatric posts before settling down as principals in their own practice, while some psychiatrists are members of both their own College and the Royal College of General Practitioners. Although there is great potential benefit for patients in this symbiotic relationship, GPs and psychiatrists work in different settings that require different techniques and time-scales. The professional work of both specialities has been profoundly affected by the National Health Service (NHS) reorganisation of the early 1990s. GPs have developed new relationships not only with psychiatric colleagues, but also with professionals of other disciplines such as psychologists, social workers and counsellors.

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Communication between general practitioners and psychiatrists

Cited by 16 publications

References 4 publications

What the eye doesn't see: drugs psychiatrists and GPs don't know their patients are on

What the eye doesn't see: drugs psychiatrists and GPs don't know their patients are on

Referrals from general practitioners to old age psychiatrists

What a general practitioner can expect from a consultant psychiatrist

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