title: Referral gridlock: primary care physicians and mental health services.
abstract: BACKGROUND
  Patients' barriers to mental health services are well documented and include social stigma, lack of adequate insurance coverage, and underdiagnosis by primary care physicians. Little is known, however, about challenges primary care physicians face arranging mental health referrals and hospitalizations.
  
  
  OBJECTIVE
  To examine how practice setting and environment influence primary care physicians' ability to refer patients for medically necessary mental health services.
  
  
  METHODS
  Cross-sectional analysis using nationally representative survey data from the 1998 to 1999 Community Tracking Study physician survey. The overall survey response rate was 61%.
  
  
  METHODS
  A 1998 to 1999 telephone survey of 6586 primary care physicians.
  
  
  METHODS
  Primary care physicians' report of whether they could obtain medically necessary referrals to high-quality mental health specialists or psychiatric admissions.
  
  
  RESULTS
  Overall, 54% of primary care physicians reported problems obtaining psychiatric hospital admissions, and 54% reported problems arranging outpatient mental health referrals. Primary care physicians practicing in staff and group model HMOs were much less apt to report difficulties than physicians in solo and small-group practices (P <.001). Reports of inadequate time with patients (P <.001) and smaller numbers of psychiatrists in a market area (P <.01) also were associated with problems obtaining mental health referrals. Pediatricians were more apt to report problems than general internists (P <.001).
  
  
  CONCLUSIONS
  Primary care physicians face greater hurdles obtaining mental health services than other medical services. Primary care is an important entry point for mental health services, yet inadequate referral systems between medical and mental health services may be hampering access.
authors.affiliation: Center for Studying Health System Change, Washington, DC, 20024-2512, USA. strude@hschange.org
authors.forename: Sally
authors.initials: S
authors.lastname: Trude
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Stoddard
mesh_terms: D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D020793:Gatekeeping / Q000592:standards / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006778:Hospitals, Psychiatric / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008605:Mental Health Services / Q000592:standards / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States