title: Pathways to Care for First Psychiatric Admissions in Lisbon.
abstract: OBJECTIVE
  This report characterizes pathways to first psychiatric admission and describes their relationship to patients' sociodemographic and clinical features.
  
  
  METHODS
  Eighty-four patients consecutively admitted for the first time in 2009-2010 to a Lisbon district psychiatric department were interviewed. Associations between pathways and clinical and sociodemographic variables were explored through univariate and multivariate analysis.
  
  
  RESULTS
  Most patients (N=49, 58%) went directly to the psychiatric emergency department and were admitted, without contacting any other care providers. This pathway was significantly associated with male gender, involuntary admission, referral by a family member, fewer people per room in the household, and lower probability of previous contact with mental health services.
  
  
  CONCLUSIONS
  The most striking feature was the high prevalence of direct access to the psychiatric emergency department with subsequent admission. Use of this direct pathway suggests that these patients were bypassing care filters, with negative consequences. Specific sociodemographic variables, but not diagnosis, were associated with filter bypass.
authors: Dr. Ramos is with the Department of Psychiatry, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal (e-mail: jmlramos@gmail.com ). Dr. Santos, Dr. Jorge, and Dr. Maia are with the Department of Psychiatry, Hospital Prof. Doutor Fernando Fonseca, Lisbon. Dr. Cardoso is with the Chronic Diseases Research Center and Department of Mental Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon.
authors: José
authors: J
authors: Ramos
authors: Dr. Ramos is with the Department of Psychiatry, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal (e-mail: jmlramos@gmail.com ). Dr. Santos, Dr. Jorge, and Dr. Maia are with the Department of Psychiatry, Hospital Prof. Doutor Fernando Fonseca, Lisbon. Dr. Cardoso is with the Chronic Diseases Research Center and Department of Mental Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon.
authors: Júlio
authors: J
authors: Santos
authors: Dr. Ramos is with the Department of Psychiatry, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal (e-mail: jmlramos@gmail.com ). Dr. Santos, Dr. Jorge, and Dr. Maia are with the Department of Psychiatry, Hospital Prof. Doutor Fernando Fonseca, Lisbon. Dr. Cardoso is with the Chronic Diseases Research Center and Department of Mental Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon.
authors: Susana
authors: S
authors: Jorge
authors: Dr. Ramos is with the Department of Psychiatry, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal (e-mail: jmlramos@gmail.com ). Dr. Santos, Dr. Jorge, and Dr. Maia are with the Department of Psychiatry, Hospital Prof. Doutor Fernando Fonseca, Lisbon. Dr. Cardoso is with the Chronic Diseases Research Center and Department of Mental Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon.
authors: Teresa
authors: T
authors: Maia
authors: Dr. Ramos is with the Department of Psychiatry, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal (e-mail: jmlramos@gmail.com ). Dr. Santos, Dr. Jorge, and Dr. Maia are with the Department of Psychiatry, Hospital Prof. Doutor Fernando Fonseca, Lisbon. Dr. Cardoso is with the Chronic Diseases Research Center and Department of Mental Health, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon.
authors: Graça
authors: G
authors: Cardoso
mesh_terms: D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D011174:Portugal; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012737:Sex Factors