Document Detail

Loss of doctor-to-doctor communication: lessons from the reconfiguration of mental health services in England.
MedLine Citation:
PMID:  18325150     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To explore the tensions across the primary-secondary interface when referral from primary care is to a team and to inform service developments in other specialties. METHODS: A nested qualitative study within a randomized controlled trial of primary care and Community Mental Health Teams (CMHTs) in Croydon and Manchester, UK. For the qualitative study, interviews were carried out with general practitioners (GPs), psychiatrists and managers or clinical leads of the CMHTs. RESULTS: GPs described the need for access to specialist knowledge, which they perceived to lie with the psychiatrist, and referral to a team was not perceived to allow this access. A personal threshold was identified by GPs after which they referred the patient to secondary care. CMHTs and psychiatrists recognized that this personal threshold differed between GPs, but their criteria for accepting referrals did not seem to allow for a flexible response to referral requests, leading to the referral being labelled as 'inappropriate'. The lack of direct doctor-to-doctor communication was perceived by respondents to contribute to a fragmentation of patient care. Strategies were described whereby the system was bypassed to achieve doctor-to-doctor communication, which undermined the team. CONCLUSIONS: Development of intermediate or 'Tier 2' services beyond the mental health services, where the GP refers to a team rather than to a specialist (hospital consultant) could benefit from reflecting on experiences with mental health services. There is a danger that new community services for the physically ill will engender the same level of confusion and discontent described by GPs and other health professionals in this study who are concerned with mental health care. Flexibility is needed within care pathways, including the provision of direct doctor-to-doctor communication together with approaches to minimize the marginalization of non-medical professionals.
Carolyn Chew-Graham; Mike Slade; Carolyn Montâna; Mairi Stewart; Linda Gask
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of health services research & policy     Volume:  13     ISSN:  1355-8196     ISO Abbreviation:  J Health Serv Res Policy     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-03-07     Completed Date:  2008-05-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9604936     Medline TA:  J Health Serv Res Policy     Country:  England    
Other Details:
Languages:  eng     Pagination:  6-12     Citation Subset:  H    
School of Community Based Medicine, University of Manchester, Manchester, UK.
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MeSH Terms
Interprofessional Relations*
Interviews as Topic
Mental Health Services / organization & administration*
Organizational Innovation
State Medicine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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