title: Does primary care mental health resourcing affect the use and costs of secondary psychiatric services?
abstract: Collaborative care models for treatment of depression and anxiety disorders in primary care have been shown to be effective. The aim of this study was to investigate at the municipal level to what extent investment in mental health personnel at primary care health centres in the study area is reflected in the costs and use of secondary psychiatric services. Furthermore, we analysed whether the service provision and use of secondary psychiatric care correlates with the socioeconomic indicators of need. We found significant variation in the amount of mental health personnel provided at the health centres, uncorrelated with the indicators of need nor with the costs of secondary psychiatric care. The amount of mental health nurses at the health centres correlated inversely with the number of secondary psychiatric outpatient visits, whereas its relation to inpatient days and admission was positive. The costs of secondary psychiatric care correlated with level of psychiatric morbidity and socioeconomic indicators of need. The results suggest that when aiming at equal access of care and cost-efficiency, the primary and secondary care should be organized and planned with integrative collaboration.
authors.affiliation: Department of Psychiatry, Hospital District of Helsinki and Uusimaa, Porvoo Health Care Area, Porvoon psykiatrian poliklinikka, Kaivokatu 37, FI-06100 Porvoo, Finland. minna.sadeniemi@hus.fi.
authors.forename: Minna
authors.initials: M
authors.lastname: Sadeniemi
authors.affiliation: Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Mannerheimintie 170, FI-00270 Helsinki, Finland. sami.pirkola@uta.fi.
authors.forename: Sami
authors.initials: S
authors.lastname: Pirkola
authors.affiliation: Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Mannerheimintie 170, FI-00270 Helsinki, Finland. maiju.pankakoski@thl.fi.
authors.forename: Maiju
authors.initials: M
authors.lastname: Pankakoski
authors.affiliation: Department of Psychiatry, University Hospital Region, Hospital District of Helsinki and Uusimaa, Välskärinkatu 12, PL 590, FI-00029 HUS, Finland. grigori.joffe@hus.fi.
authors.forename: Grigori
authors.initials: G
authors.lastname: Joffe
authors.affiliation: Department of Psychiatry, Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Vanha Valtatie 198, FI-04500 Kellokoski, Finland. raija.kontio@hus.fi.
authors.forename: Raija
authors.initials: R
authors.lastname: Kontio
authors.affiliation: Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Mannerheimintie 170, FI-00270 Helsinki, Finland. maili.malin@thl.fi.
authors.forename: Maili
authors.initials: M
authors.lastname: Malin
authors.affiliation: Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Mannerheimintie 170, FI-00270 Helsinki, Finland.
authors.forename: Taina
authors.initials: T
authors.lastname: Ala-Nikkola
authors.affiliation: Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Mannerheimintie 170, FI-00270 Helsinki, Finland. kristian.wahlbeck@thl.fi.
authors.forename: Kristian
authors.initials: K
authors.lastname: Wahlbeck
mesh_terms: D005387:Finland; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000191:economics / Q000458:organization & administration; D006760:Hospitalization; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D063728:Secondary Care Centers / Q000706:statistics & numerical data