This is part two of Dr. Puyat’s thesis work. Read part one.
Research led by CHÉOS Scientist Dr. Joseph Puyat and his colleagues at the UBC School of Population and Public Health (SPPH) has concluded that the B.C. physician incentives program has had a mild to modest effect on mental health care, but that more is needed to close existing gaps in treatment.
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 of GPs, and to improve patient care. The 6 indicators included minimally adequate antidepressant therapy (MAAT), defined as 84 or more days of antidepressant therapy (AT), and minimally adequate counselling/psychotherapy (MACP), defined as 4 or more counselling/psychotherapy (CP) sessions.
The authors concluded that physician incentives had a modest impact on mental health care. Five years after the incentives were introduced, the percentage of people who received at least one session of CP increased by 3.3 per cent and the percentage of people who received AT decreased by 4.5 per cent.
The percentage of people who received MACP rose 1.8 per cent, what the researchers categorized as a “surprisingly low” impact over time, which suggests additional barriers to receiving MACP other than financial disincentives. Results also showed that the physician incentives program stabilized the decline in the GP-patient relationship and continuity of care.
An unexpected finding was the increase in the use of counselling services, but a decline in antidepressant therapy. Researchers suggest that this could be due to physician incentives discouraging the provision of non-incentivized services.
Dr. Puyat said that while there had been an impact of the physician incentives program on mental health care, it would not have a substantial effect in closing the gap in treatment.
“I think it’s about time that other evidence-based interventions be explored at the population level,” he said, which could include team-based and collaborative care models. “Physicians are already overloaded with work and might not have the time to do the work required. We can only stretch physicians to a certain extent.”
This study is part of Dr. Puyat’s thesis work at SPPH. Drs. Arminee Kazanjian and Hubert Wong from UBC SPPH, and Elliot Goldner from SFU are co-authors.
