Abstract

Background: Primary care providers use referrals to communicate with mental health specialists about their patients’ conditions. However, these referrals are not standardized, resulting in a potentially wide variance in referral quality that, in turn, can affect the quality of patient care. Our aim was to evaluate the caliber of these referrals in Qatar, a country with high mental health utilization rates but with comparatively underdeveloped psychiatry resources at the primary care level.

Materials and Methods: We collected 234 psychiatric referrals from Qatari primary care clinics and assessed their quality using a seven-item inclusion checklist derived from existing research and best practices. Checklist items included: 1) history of present illness (HPI); 2) mental status examination (MSE); 3) risk assessment; 4) past medical history; 5) use of psychiatric assessment tools; 6) treatment given in the primary care setting and 7) reason for referral. The importance of each of these seven items was independently rated by 18 psychiatrists.

Results: Psychiatrists rated all of the checklist items as important, with “reason for referral” and HPI rated as most important. Out of 228 valid referrals, 79.8% were accepted. 31% of all referrals contained an HPI; 18.85% contained an MSE; 11.4% included a suicide risk assessment; 16.2% included past medical history; 35.5% used a psychiatric assessment tool; 18.6% described treatment given in primary care; 46.5% included the reason for referral. No single checklist item was included in at least half the referrals.

Conclusion: Mental health referrals from primary care physicians in Qatar suffer from a profound lack of basic data; reasons for this may include gaps in primary care physicians’ knowledge and self-efficacy about mental health care. Primary care physicians must be supported to improve referral quality, which will result in better and more efficient mental health care delivery.

Limitations: Study limitations include the use of subjective survey data to assess the face validity of the checklist items.

Key words: primary care, referrals, psychiatry, mental health treatment, quality improvement,
mental health care, Qatar