Assessing Primary Care Contributions to Behavioral Health: A Cross-sectional Study Using Medical Expenditure Panel Survey

Abstract

Objectives To assess primary care contributions to behavioral health in addressing unmet mental healthcare needs due to the COVID-19 pandemic. Methods Secondary data analysis of 2016 to 2018 Medical Expenditure Panel Survey of non-institutionalized US adults. We performed bivariate analysis to estimate the number and percentage of office-based visits and prescription medications for depression and anxiety disorders, any mental illness (AMI), and severe mental illness (AMI) by physician specialty (primary care, psychiatry, and subspecialty) and medical complexity. We ran summary statistics to compare the differences in sociodemographic factors between patients with AMI by seeing a primary care physician versus those seeing a psychiatrist. Binary logistic regression models were estimated to examine the likelihood of having a primary care visit versus psychiatrist visit for a given mental illness. Results There were 394 023 office-based visits in the analysis sample. AMI patients seeing primary care physician were thrice as likely to report 1 or more chronic conditions compared to those seeing psychiatrist. Among patients with a diagnosis of depression or anxiety and AMI the proportion of primary care visits ([38% vs 32%, P < .001], [39% vs 34%, P < .001] respectively), and prescriptions ([50% vs 40%, P < .001], [47% vs 44%, P < .05] respectively) were higher compared to those for psychiatric care. Patients diagnosed with SMI had a more significant percentage of prescriptions and visits to a psychiatrist than primary care physicians. Conclusion Primary care physicians provided most of the care for depression, anxiety, and AMI. Almost a third of the care for SMI and a quarter of the SMI prescriptions occurred in primary care settings. Our study underscores the importance of supporting access to primary care given primary care physicians’ critical role in combating the COVID-19 related rise in mental health burden.

COVID-19 Is Associated With an Increase in Visits for Anxiety but Not Depression

“…We also found that while the number of visits for depression was similar in the return period compared to the pre-period, the number of visits for anxiety was higher. Understanding the changes in visits for depression and anxiety in primary care is particularly important as most patients with a mental illness consult a primary care physician [ 11 ].…”

Recognizing primary care in behavioral health workforce assessments.

“…More specific contributions of primary care in addressing mental health needs were studied in a recent article published in the Journal of Primary Care & Community Health (Jetty et al, 2021). Data from 2016–2018 revealed that, on average, 40% of all acute mental illness visits were completed by a PCP in the primary care setting.…”

“…This is in line with prior literature by Xierali et al (2013), which indicates that PCPs serve as the primary managers of psychiatric illness in roughly one third of their patients and that two thirds of patients with depression receive treatment for their depressions from PCPs. Given a large percentage of mental health needs are identified and managed by PCPs, it is problematic that they were not considered in the AAMC’s workforce modeling (Donaldson et al, 1996; Jetty et al, 2021; Xierali et al, 2013). As evidenced above, any workforce increases to meet unmet mental health needs would undoubtedly lead to an increased demand for PCPs as well.…”

Something Republicans and Democrats can agree on: Support for integrated behavioral health.

“…(1) Primary care clinicians already identify and treat mild to moderate behavioral health conditions, particularly depression and anxiety disorders (Jetty et al, 2021; University of Michigan Behavioral Health Workforce Research Center, 2019). The treatment primary care practices can provide is greatly expanded in scope by integrated behavioral health.…”

“…To advocate to move these recommendations forward, we must be clear first on what we mean by integrated behavioral health in primary care and then address misperceptions. Primary care clinicians already identify and treat mild to moderate behavioral health conditions, particularly depression and anxiety disorders (Jetty et al, 2021; University of Michigan Behavioral Health Workforce Research Center, 2019). The treatment primary care practices can provide is greatly expanded in scope by integrated behavioral health.…”