Development of a System for Identifying Community-dwelling Outpatients with Mental Disorders Needing Emergency Management Amid a Public Health Emergency by General Practitioners

ABSTRACT

Background: In the context of public health emergencies, for example, the COVID-19 pandemic, community hospitals may face challenges to provide diagnosis and treatment services and to reduce the disease burden for patients with mental problems. However, general practitioners(GPs)' capabilities in diagnosing and treating mental disorders are unsatisfactory. Objective: To develop a system for identifying community-dwelling outpatients with mental disorders needing emergency management amid a public health emergency by GPs, to promote GPs' capabilities in diagnosing and treating mental disorders, and the health of such patients. Methods: From May to June 2020, based on a literature review and an investigation of work requirements for GPs, we formed a framework for identifying community-dwelling outpatients with mental disorders needing emergency management amid a public health emergency by GPs with indicators initially determined. Then we screened and revised the indicators according to the results of a two-round Delphi survey with 15 experts(in the field of general practice or mental health medicine), and finally determined the indicators(with a mean value of weighted importance>3.5, coefficient of variation <25%, and rate of getting full marks >20%) for the formal system identifying community-dwelling outpatients with mental disorders needing emergency management amid a public health emergency by GPs. Results: Information of the experts surveyed 13 of them had a graduate degree, and 10 had a senior professional title. Positive coefficients of the experts All the experts(100%) actively responded to the two rounds of survey. Authority coefficients of the experts the authority coefficient of the six domains were >0.70. The degree of agreement between the experts the Kendall's W in the second round of survey was 0.278(χ2=100.197, P<0.001), which was higher than 0.245(χ2=73.597, P<0.001)in the first round of survey. The final indicators 24 indicators in six domains involving mental symptoms, diagnosis of mental illness, severity of mental illness, personality, physical status, family and social background. Conclusion: Our system may help GPs to high-efficiently identify community-dwelling outpatients with severe mental disorders needing emergency treatment or referrals. However, the accuracy of the system needs to be verified further. Copyright © 2021 by the Chinese General Practice.