COMMUNITY RESOURCES FOR PSYCHIATRIC AND PSYCHOSOCIAL PROBLEMS - FAMILY PHYSICIANS REFERRAL PATTERNS IN URBAN ONTARIO

OBJECTIVE To document the number and pattern of psychiatric and psycho social referrals to community resources by family physicians (FPs) and to determine whether referral practices correlate with physician vari ables. DESIGN Cross-sectional survey of referrals by FPs to 34 key psy chiatric and psychosocial community resources identified by a panel of FPs, psychiatric social workers, psychiatric nurses, public health nu rses, and the local community information service. SETTING Regional mu nicipality of 434 000 persons in Ontario. PARTICIPANTS Twenty-seven of 34 (79%) community agencies identified 261 FPs who made 4487 referral s to participating agencies (range 0 to 65, median 15, mean 17.19 +/- 13.42). MAIN OUTCOME MEASURES Number of referrals to all agencies; var iables, such as physician sex, school of graduation, year of graduatio n, and certificant status in the College of Family Physicians of Canad a, related to referral patterns.RESULTS Referrals to outpatient psychi atric clinics, support services, and general counseling services accou nted for 96% of all referrals. Physicians' average annual referral pro file was as follows: 8.6 patients to a support service, 6.3 to an outp atient psychiatric service, 1.6 to a counseling service, and 0.46 to a substance abuse service. Referral profiles of individual physicians v aried greatly. Female FPs made fewer referrals than male FPs to suppor t services, but both made similar numbers of referrals to psychiatric, counseling, and substance abuse services. The more recent the year of graduation, the greater the number of referrals to psychiatric (r = 0 .158, P = 0.0107) and counseling services (r = 0.137, P = 0.0272) and the higher the fraction of referrals to psychiatric services (r = 0.28 6, P = 0.0001). CONCLUSIONS Family physicians in Hamilton-Wentworth ma de few referrals to psychiatric and psychosocial services. Only physic ian sex and year of graduation correlated significantly with numbers o f referrals made. Recent graduates of both sexes made significantly mo re referrals to psychiatric clinics and counseling services than their older colleagues.