Better outcomes in mental health care: impact of different models of psychological service provision on patient outcomes.
OBJECTIVE
One hundred and eight Access to Allied Psychological Services projects have been funded under Australia's Better Outcomes in Mental Health Care programme since July 2001. All projects are run by Divisions of General Practice and enable general practitioners (GPs) to refer patients to allied health professionals for evidence-based care. They differ in the models they use to retain, locate and direct referrals to their allied health professionals. This paper examines the extent to which the projects are achieving positive patient outcomes, and explores the association between different models of service delivery and varying levels of patient outcomes.


METHODS
The paper draws on two data sources (a purpose-designed minimum dataset and a survey of models of service delivery) to examine the level of patient outcomes within and across projects, and variations in the level of patient outcomes by models of service delivery.


RESULTS
The projects are achieving positive effects and these are mostly of large or medium magnitude. The projects do not differ markedly in terms of the patient outcomes they are achieving, despite differences in the models of service delivery they are using. However, those projects implementing a direct referral model, where the GP refers the patient directly to the allied health professional, have significantly greater effect sizes, indicating that they are achieving greater improvements in patient outcomes. In addition, there are non-significant trends toward direct employment of allied health professionals by Divisions being predictive of greater improvements in patient outcomes, and delivery of services from allied health professionals' own rooms being predictive of weaker patient outcomes.


CONCLUSIONS
Overwhelmingly, the Access to Allied Psychological Services projects are having a positive impact for patients in terms of their level of functioning, severity of symptoms and/or quality of life. Preliminary indications suggest that a service delivery model incorporating the use of a direct referral system may be associated with superior outcomes. The findings are discussed in the light of the imminent listing of psychologists' services on the Medicare Benefits Schedule.
Morley
Belinda
B
Program Evaluation Unit, School of Population Health, University of Melbourne, Melbourne, Vic. 3010, Australia. bcmorley@unimelb.edu.au
Pirkis
Jane
J
Sanderson
Kristy
K
Burgess
Philip
P
Kohn
Fay
F
Naccarella
Lucio
L
Blashki
Grant
G
D001315:Australia; D003695:Delivery of Health Care; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000458:organization & administration*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D016896:Treatment Outcome