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.

Key words: General practitioners, Mental disorders, Ambulatory care, Public health emergency, Indexs of urgent disposition

摘要： 背景　突发公共卫生事件，如新型冠状病毒肺炎疫情下，社区精神心理问题的诊治需求和疾病负担增大，而全科医生对其的诊治却存在较多欠缺。目的　基于突发公共卫生事件视角，对全科医生识别社区门诊精神障碍患者的紧急处置指标进行构建，以提高全科诊治率，促进患者健康。方法　于2020年5—6月，针对全科医生实际工作需求，通过德尔菲法构建用于全科医生识别需紧急处置的社区门诊精神障碍患者的系统指标。首先在文献查阅的基础上，初步提出全科医生需紧急处置的社区门诊精神障碍患者的体系框架和潜在指标，而后选取15名从事全科医学、精神心理卫生医学的专家进行两轮专家函询，结合专家提出的意见进行指标筛选和完善，保留重要性赋值均数>3.5分、变异系数<25%、满分率>20%的指标，最终明确需紧急处置的评估判断指标。结果　15名函询专家中，13名具有研究生学历，10名具有高级职称。专家积极程度：两轮问卷回收率皆为100.0%。专家权威程度：6个一级指标的专家权威系数均>0.70。第1、2轮二级指标的重要性协调系数分别为0.245（χ2=73.597，P<0.001）和0.278（χ2=100.197，P<0.001），第二轮大于第一轮。指标确立：经两轮评议最终获得包含精神症状、精神疾病诊断、精神疾病严重程度、人格异常、躯体情况、家庭社会背景共6项一级指标、24项二级指标。结论　对社区门诊急重症精神障碍患者的识别体系指标构建可以帮助全科医生高效地识别和评估需紧急治疗或转诊者，有待进一步应用研究。

关键词: 全科医生, 精神障碍, 门诊医疗, 突发公共卫生事件, 紧急处置指标