title: Factors explaining the use of psychiatric services by general practices.
abstract: BACKGROUND
  Referral rates from general practitioners to hospital services vary up to 25-fold, and several studies have sought reasons for this apparent inconsistency in clinical practice. However, few studies have concentrated on, or indeed included, psychiatric patients or psychiatric referral rates.
  
  
  OBJECTIVE
  To determine the effect of population, general practice, and mental health service factors on use of specialist mental health services by general practices.
  
  
  METHODS
  Cross-sectional data from computerized records used in managing clinical care on all patients aged 16 to 64 years who had been in contact with any mental health service staff over a two-year period. Twenty-three practices in Huntingdon Health District were studied, with a list population of 87,643 patients aged 16 to 64 years, served by one inpatient ward and three community mental health teams. The main outcome measures were the relation between age-standardized utilization ratio and markers of morbidity, deprivation, community mental health provision, and practice prescribing.
  
  
  RESULTS
  Variation between practices in the use of mental health services was relatively limited, especially compared with the use of other secondary medical and surgical services. Three factors together explained 60.8% of the variance in use between practices: a census-based index of long-term limiting illness in females registered with the practice, use of one of the three community mental health teams, and average quarterly defined daily doses of hypnotics prescribed per practice population. Relatively high prescribing of hypnotics was associated with lower service use.
  
  
  CONCLUSIONS
  Population morbidity and factors in the mental health service explain a substantial part of the variation in the use of mental health services between practices. Further work is needed to replicate these findings and explore why team factors and prescribing patterns influence utilization ratios. This study underlines the importance of examining population, practice, and specialist service factors in explaining variation in the use of secondary care by general practices.
authors.affiliation: Department of Community Medicine, University of Cambridge.
authors.forename: D
authors.initials: D
authors.lastname: Melzer
authors.forename: L
authors.initials: L
authors.lastname: Watters
authors.forename: E
authors.initials: E
authors.lastname: Paykel
authors.forename: K
authors.initials: K
authors.lastname: Singh
authors.forename: N
authors.initials: N
authors.lastname: Gormley
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012044:Regression Analysis