Too little time? The recognition and treatment of mental health problems in primary care.
OBJECTIVE
To assess the effect of practice characteristics on the diagnosis and treatment of mental health problems in primary care.


METHODS
National Ambulatory Medical Care Survey (NAMCS) 1991-1994.


METHODS
We examine the effect of visit characteristics and practice characteristics on rates of diagnosis of mental health problems, rates of referral, and rates of use of psychotropic medications. We characterize each primary care physician's practice using information about the ways in which that physician treated patients who did not have mental health problems.


RESULTS
We find that median visit duration has a small, statistically insignificant effect on the rate of diagnosis and treatment of mental health problems. Physicians with large HMO caseloads are slightly more likely to diagnose mental health problems, but less likely to prescribe psychotropic medications, than are physicians who see few HMO patients. Practice style and specialty are important determinants of diagnosis and, to a lesser extent, of treatment.


CONCLUSIONS
Physicians specialty and practice style are more strongly related to mental health diagnosis and treatment than are system characteristics such as visit duration and insurance composition.
Division of Health Policy and Management, Columbia School of Public Health, New York, NY 10032, USA.
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Glied
D000293:Adolescent; D000328:Adult; D001071:Appointments and Schedules; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005194:Family Practice / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy*; D008875:Middle Aged; D016017:Odds Ratio; D009819:Office Visits; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014481:United States; D016526:Workload
D011619:Psychotropic Drugs