Time to explore other measures to close mental health gap – research

Research by School of Population and Public Health (SPPH) alumnus and faculty has concluded that the impact of physician incentives on mental health care has been “modest”, and it is time to explore other approaches.

Published in September in Medical Care, the study looked at linked health data for eligible B.C. residents diagnosed with major depression between January 2005 and December 2012, divided into monthly cohorts, and tracked their use of mental health services for 12 months following initial diagnosis.

The research used six indicators to measure the impact of the physician incentives, which took effect in 2008 and were intended to recognize the investment in time and skill such patients require in GPs, and to improve patient care, according to the GPSC. The six indicators included minimally adequate antidepressant therapy [MAAT], defined as 84 or more days of AT, and minimally adequate counseling/psychotherapy [MACP], defined as four or more CP sessions.

The research found that five years after the incentives were introduced, the percentage of people who received at least one session of CP increased by 3.3 percentage points and the percentage of people who received AT decreased by 4.5 percentage points.

The percentage of people who received MACP rose 1.8 percentage points, a “surprisingly low” impact over time, suggesting other barriers to receiving MACP than financial disincentives, the authors said.

The percentage of people who received MAAT dropped by 2.2 percentage points five years after the incentives were introduced, a finding that the authors did not expect and which they suggested could be due to physician incentives discouraging the provision of non-incentivized services.

The authors concluded that physician incentives had a modest impact on mental health care.

Lead author Dr. Joseph Puyat, an SPPH alumnus, said the research showed it was time to explore other approaches to addressing that gap in mental health care. While there had been an impact, it would not have a substantial effect in closing this gap, he said.

“I think it’s about time that other evidence based interventions be explored at the population level.”
Dr. Joseph Puyat

Other interventions currently being investigated include team-based and collaborative care models, he said. Physicians were already overloaded and might not have the time to do the work required. “We can only stretch physicians to a certain extent.”

SPPH Professor Arminée Kazanjian, co-author and Dr. Puyat’s doctoral supervisor, said it was clear that many complex factors underlie timely and appropriate diagnosis and treatment in mental health.

“Adding a few fee items to the list of what GPs can be paid for some additional time for patients with MDD will not address a major structural issue: ease of access for younger and older patients to multidisciplinary health professionals for counseling /psychotherapy and adequate follow-up.”
Professor Arminée Kazanjian

SPPH Associate Professor Hubert Wong is also a co-author of the article.

Photo credit: iStock

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