Primary care reform and funding equity for mental health disorders in Ontario: a retrospective observational population-based study

Bayoumi, Imaan; Schultz, Susan; Glazier, Richard H.

doi:10.9778/cmajo.20190153

Cited by 6 publications

(7 citation statements)

References 35 publications

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“…27 Self-harm behaviour (eg, deliberate drug overdose or self-inflicted traumatic injury) were identified by using the ICES Mental Health and Addictions Scorecard and Evaluation Framework, 28 as previously reported. 27 29 …”

Section: Methodsmentioning

confidence: 99%

Suicide and self-harm in adult survivors of critical illness: population based cohort study

Fernando

Qureshi²,

Sood³

et al. 2021

BMJ

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Objective To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. Design Population based cohort study using linked and validated provincial databases. Setting Ontario, Canada between January 2009 and December 2017 (inclusive). Participants Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. Main outcome measures The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. Results 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors ( v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56). Conclusions Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.

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Section: Methodsmentioning

confidence: 99%

Suicide and self-harm in adult survivors of critical illness: population based cohort study

Fernando

Qureshi²,

Sood³

et al. 2021

BMJ

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“…51,54,55 To ensure physicians have the appropriate resources, compensation models should better reflect patient complexity. 18,56 Equally important, policies should include measures to ensure high-quality care for complex and stigmatized populations. These could include requirements for enhanced education in medical schools and anti-oppression training for primary care practices.…”

Section: Discussionmentioning

confidence: 99%

Examining Access to Primary Care for People With Opioid Use Disorder in Ontario, Canada

et al. 2022

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ImportancePeople with opioid use disorder are less likely than others to have a primary care physician.ObjectiveTo determine if family physicians are less likely to accept people with opioid use disorder as new patients than people with diabetes.Design, Setting, and ParticipantsThis randomized clinical trial used an audit design to survey new patient intake at randomly selected family physicians in Ontario, Canada. Eligible physicians were independent practitioners allowed to prescribe opioids who were located in an office within 50 km of a population center greater than 20 000 people. A patient actor made unannounced telephone calls to family physicians asking for a new patient appointment. The data were analyzed in September 2021.InterventionIn the first randomly assigned scenario, the patient actor played a role of patient with diabetes in treatment with an endocrinologist. In the second scenario, the patient actor played a role of a patient with opioid use disorder undergoing methadone treatment with an addiction physician.Main Outcomes and MeasuresTotal offers of a new patient appointment; a secondary analysis compared the proportions of patients offered an appointment stratified by gender, population, model of care, and years in practice.ResultsOf a total 383 family physicians included in analysis, a greater proportion offered a new patient appointment to a patient with diabetes (21 of 185 physicians [11.4%]) than with opioid use disorder (8 of 198 physicians [4.0%]) (absolute difference, 7.4%; 95% CI, 2.0 to 12.6; P = .007). Physicians with more than 20 years in practice were almost 13 times less likely to offer an appointment to a patient with opioid use disorder compared with diabetes (1 of 108 physicians [0.9%] vs 10 of 84 physicians [11.9%]; absolute difference, 11.0; 95% CI, 3.8 to 18.1; P = .001). Women were almost 5 times less likely (3 of 111 physicians [2.7%] vs 14 of 114 physicians [12.3%]; absolute difference, 9.6%; 95% CI, 2.4 to 16.3; P = .007) to offer an appointment to a patient with opioid use disorder than with diabetes.Conclusions and RelevanceIn this randomized clinical trial, family physicians were less likely to offer a new patient appointment to a patient with opioid use disorder compared with a patient with diabetes. Potential health system solutions to this disparity include strengthening policies for accepting new patients, improved compensation, and clinician anti-oppression training.Trial RegistrationClinicalTrials.gov Identifier: NCT05484609

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“…Our study provides a qualitative insight to help understand recent quantitative research on funding for mental health disorders since primary care reforms were implemented [71]. While budget sizes for mental health care can dramatically influence the quantity and quality of available services [68], the lack of continuity in that funding undermines the practices' ability to deliver care.…”

Section: Fundingmentioning

confidence: 98%

Inequities in the delivery of mental health care: a grounded theory study of the policy context of primary care

Ashcroft

Menear

Silveira

et al. 2021

Int J Equity Health

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Background Strengthening capacity for mental health in primary care improves health outcomes by providing timely access to coordinated and integrated mental health care. The successful integration of mental health in primary care is highly dependent on the foundation of the surrounding policy context. In Ontario, Canada, policy reforms in the early 2000’s led to the implementation of a new interprofessional team-model of primary care called Family Health Teams. It is unclear the extent to which the policy context in Ontario influenced the integration of mental health care in Family Health Teams emerging from this period of policy reform. The research question guiding this study was: what were key features of Ontario’s policy context that influenced FHTs capacity to provide mental health services for mood and anxiety disorders? Methods A qualitative study informed by constructivist grounded theory. Individual interviews were conducted with executive directors, family physicians, nurse practitioners, nurses, and the range of professionals who provide mental health services in interprofessional primary care teams; community mental health providers; and provincial policy and decision makers. We used an inductive approach to data analysis. The electronic data management programme NVivo11 helped organise the data analysis process. Results We conducted 96 interviews with 82 participants. With respect to the contextual factors considered to be important features of Ontario’s policy context that influenced primary care teams’ capacity to provide mental health services, we identified four key themes: i) lack of strategic direction for mental health, ii) inadequate resourcing for mental health care, iii) rivalry and envy, and, iv) variations across primary care models. Conclusions As the first point of contact for individuals experiencing mental health difficulties, primary care plays an important role in addressing population mental health care needs. In Ontario, the successful integration of mental health in primary care has been hindered by the lack of strategic direction, and inconsistent resourcing for mental health care. Achieving health equity may be stunted by the structural variations for mental health care across Family Health Teams and across primary care models in Ontario.

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Primary care reform and funding equity for mental health disorders in Ontario: a retrospective observational population-based study

Cited by 6 publications

References 35 publications

Suicide and self-harm in adult survivors of critical illness: population based cohort study

Suicide and self-harm in adult survivors of critical illness: population based cohort study

Examining Access to Primary Care for People With Opioid Use Disorder in Ontario, Canada

Inequities in the delivery of mental health care: a grounded theory study of the policy context of primary care

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