Who treats whom? An application of the Pathways to Care model in Australia.
OBJECTIVE
The present paper applies Goldberg and Huxley's Pathways to Care (PTC) model to the Australian health-care system to ask: who is treated in each sector and what does this tell us about the performance of the health-care system? It examines the factors associated with reaching primary care, outpatient and inpatient sectors, as well as private and public mental health services.


METHODS
Data from the Australian National Survey of Mental Health and Wellbeing were used to determine the proportion of the population treated in each sector. Sociodemographic and clinical characteristics were examined and logistic regression was used to determine which factors were associated with use of different sectors of care.


RESULTS
Of the total population, 80.5% reached primary care, 8.2% primary care for mental health problems, 6.5% outpatient care and 0.4% reached the mental health inpatient sector. Clinical severity increased across these sectors and was an important determinant of access to care. Those consulting private practitioners were clinically similar to those consulting in the public sector. Sociodemographic characteristics were important determinants of access to primary, specialist and private mental health care. Being aged over 55 years or living in a rural area was associated with lower access to several sectors.


CONCLUSIONS
Although at a broad level the health-care system is performing as expected, limited access among some groups is cause for concern. Applying the PTC model to a population sample offered useful insights into the performance of the Australian health-care system.
Issakidis
Cathy
C
Policy and Epidemiology Group, School of Psychiatry, University of New South Wales, and WHO Collaborating Centre at St Vincent's Hospital, Sydney, Australia.
Andrews
Gavin
G
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001315:Australia / Q000453:epidemiology; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy*; D008605:Mental Health Services / Q000145:classification / Q000458:organization & administration*; D008875:Middle Aged; D017146:Models, Organizational; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D017149:Private Sector / Q000706:statistics & numerical data; D011570:Psychiatry / Q000706:statistics & numerical data; D011586:Psychology, Clinical / Q000706:statistics & numerical data; D017150:Public Sector / Q000706:statistics & numerical data; D012949:Social Work, Psychiatric / Q000706:statistics & numerical data