BACKGROUND: Psychological therapies are effective treatments for common mental health problems, but access is limited. GPs face difficult decisions as to whom to refer, but little is known about this decision-making process. AIM: To explore GPs' accounts of decisions to refer, or not refer, patients for psychological therapy. DESIGN OF STUDY: A qualitative study, using a matched-patient procedure. SETTING: General practices in two inner London boroughs. METHOD: In semi-structured interviews, GPs were asked to compare and contrast five matched-patient pairs, consisting of patients who had been referred for psychological therapy paired with patients not referred. The interviews were analysed using a general thematic analysis. RESULTS: Fourteen GPs discussed 130 matched patients (65 patient pairs). Three main factors distinguished GPs' accounts of the patients they referred compared with the matched patients they did not refer. These factors were: patient initiative in requesting or showing interest in referral; estimated capacity of the patient to benefit from psychological therapy; and the GP's own capacity to help the patient in terms of skills, expertise, and time. CONCLUSION: GPs gave accounts of themselves acting as rational decision makers, judging how effective they thought a referral would be based on a patient's clinical presentation and motivation, compared with the GPs' own ability to help.
BACKGROUND: Psychological therapies are effective treatments for common mental health problems, but access is limited. GPs face difficult decisions as to whom to refer, but little is known about this decision-making process. AIM: To explore GPs' accounts of decisions to refer, or not refer, patients for psychological therapy. DESIGN OF STUDY: A qualitative study, using a matched-patient procedure. SETTING: General practices in two inner London boroughs. METHOD: In semi-structured interviews, GPs were asked to compare and contrast five matched-patient pairs, consisting of patients who had been referred for psychological therapy paired with patients not referred. The interviews were analysed using a general thematic analysis. RESULTS: Fourteen GPs discussed 130 matched patients (65 patient pairs). Three main factors distinguished GPs' accounts of the patients they referred compared with the matched patients they did not refer. These factors were: patient initiative in requesting or showing interest in referral; estimated capacity of the patient to benefit from psychological therapy; and the GP's own capacity to help the patient in terms of skills, expertise, and time. CONCLUSION: GPs gave accounts of themselves acting as rational decision makers, judging how effective they thought a referral would be based on a patient's clinical presentation and motivation, compared with the GPs' own ability to help.
Authors: Richard L Kravitz; Peter Franks; Mitchell Feldman; Lisa S Meredith; Ladson Hinton; Carol Franz; Paul Duberstein; Ronald M Epstein Journal: J Gen Intern Med Date: 2006-06 Impact factor: 5.128
Authors: E Kaltenthaler; J Brazier; E De Nigris; I Tumur; M Ferriter; C Beverley; G Parry; G Rooney; P Sutcliffe Journal: Health Technol Assess Date: 2006-09 Impact factor: 4.014
Authors: Richard L Kravitz; Ronald M Epstein; Mitchell D Feldman; Carol E Franz; Rahman Azari; Michael S Wilkes; Ladson Hinton; Peter Franks Journal: JAMA Date: 2005-04-27 Impact factor: 56.272
Authors: Judith Gellatly; Peter Bower; Sue Hennessy; David Richards; Simon Gilbody; Karina Lovell Journal: Psychol Med Date: 2007-02-19 Impact factor: 7.723
Authors: Sophie Pettit; Adam Qureshi; William Lee; Alex Stirzaker; Alex Gibson; William Henley; Richard Byng Journal: Br J Gen Pract Date: 2017-06-05 Impact factor: 5.386
Authors: Yvonne F Awenat; Sarah Peters; Patricia A Gooding; Daniel Pratt; Charlotte Huggett; Kamelia Harris; Christopher J Armitage; Gillian Haddock Journal: PLoS One Date: 2019-09-24 Impact factor: 3.240
Authors: Linda Gask; Peter Bower; Jonathan Lamb; Heather Burroughs; Carolyn Chew-Graham; Suzanne Edwards; Derek Hibbert; Marija Kovandžić; Karina Lovell; Anne Rogers; Waquas Waheed; Christopher Dowrick Journal: BMC Health Serv Res Date: 2012-08-13 Impact factor: 2.655