Referral from primary care to a child and adolescent psychiatry unit in the North of Portugal: a 2-year analysis

Abstract

Objectives: To characterize the referrals from Primary Health Care (PHC) to the child and adolescent psychiatry consultation unit of the Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E) and to evaluate the communication between these two levels of care. Study design: Cross-sectional. Setting: Child and Adolescent Psychiatry Unit of Psychiatry and Mental Health Service of CHVNG/E. Population: Our sample included all referrals from primary care to the referral unit, using ALERT P1®, in 2010 and 2011. Methods: Descriptive analyses were performed regarding gender, age, reason for referral, priority of the referral, priority given by the psychiatrist, reason for refusal or return of referral, waiting time, patient attendance, and quality of the referral letter. Results: Our analysis was based in 980 referrals (61.5% male). Patients aged 6-10 years were the most commonly referred (41.4%). The most frequent reason for referral was ‘signs and symptoms of child behaviour’ (31.9%). Of all referrals, 16.9% were considered urgent by the family doctor. Of these, 11.6% were considered as urgent by the psychiatrist. Of all referrals, 11.3% were refused or returned, mainly because of insufficient information (36.1%). About 90% of the referrals considered as priorities were scheduled within ≤ 60 days and almost 100% of the remaining referrals were scheduled within ≤ 150 days. Of the 853 scheduled first consultations, 10.5% of the children missed the consultation and did not ask for another appointment. About 20% of the referral letters were considered of good quality and about 14% were considered of poor quality. Conclusions: Our results suggest that communication between family doctors and child and adolescent psychiatrists is effective. Some aspects need improvement, particularly the definition of urgency and the quality of information in the referral letters.