Population-based use of mental health services and patterns of delivery among family physicians, 1992 to 2001.
OBJECTIVE
To examine 9-year rates of family physician (FP) and psychiatrist use, as well as patterns of mental health services delivery by FPs.


METHODS
We used population-based data from Winnipeg, Manitoba, to construct mutually exclusive cohorts of adults treated for major or minor mental health disorders in fiscal years 1992-1993 to 2000-2001. For each year, we measured patterns of use in this population and patterns of mental health practice among FPs.


RESULTS
The treatment prevalence rate was 224 per 1000 in 2000-2001 and 174 per 1000 in 1992-1993, and the rates for major and minor mental health disorders increased over the 9-year period by 15% and 31%, respectively. In 2000-2001, 92% of adults treated for mental illness saw at least one FP, and 45% saw an FP but no psychiatrist. Adults with major or minor mental health disorders visited an FP on average 9.1 and 6.9 times yearly, respectively, and FP visit rates remained relatively stable. There was a gradient in use by socioeconomic status: adults from communities with lower socioeconomic status had the highest rates of use. By 2000-2001, 24% of FPs billed for services related to psychosocial conditions as often as they did for the most frequent conditions seen in primary care.


CONCLUSIONS
Between 1992-1993 and 2000-2001, the study population's patterns of FP and psychiatrist use remained relatively stable. In more recent years, FPs provided more mental health services than in previous years; this related to increased treatment prevalence rather than to increases in use per adult. FPs played a major role in the provision of mental health care.
Watson
Diane E
DE
Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg. dwatson@chspr.ubc.ca
Heppner
Petra
P
Roos
Noralou P
NP
Reid
Robert J
RJ
Katz
Alan
A
D000328:Adult; D003695:Delivery of Health Care / Q000639:trends; D005194:Family Practice / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008350:Manitoba; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012959:Socioeconomic Factors