title: Primary care reform and service use by people with serious mental illness in Ontario.
abstract: OBJECTIVE
  To examine service use by adults with serious mental illness (SMI) rostered in new primary care models: enhanced fee-for-service (FFS), blended-capitation (CAP) and team-based capitation (TBC) models with and without mental health workers (MHW) in Ontario.
  
  
  METHODS
  This cross-sectional study used administrative health service databases to compare use of mental health and general health services among persons with SMI enrolled in new models (n = 125,233).
  
  
  RESULTS
  Relative to persons rostered in enhanced FFS, those in CAP and TBC had fewer mental health primary care visits (adjusted rate ratios and 95% confidence limits: CAP: 0.77 [0.74, 0.81]; TBC with MHW: 0.72 [0.68, 0.76]; TBC with no MHW: 0.81 [0.72, 0.93]). Compared to patients in enhanced FFS, those in TBC models also had more mental health hospital admissions (TBC with MHW: 1.12 [1.05, 1.20]; TBC with no MHW: 1.22 [1.05, 1.41]). Patterns of use of general services were similar.
  
  
  CONCLUSIONS
  Further attention to financial incentives in capitation that influence care of persons with SMI is necessary to determine if they are aligned with aims of primary care reform.
authors.affiliation: Methadone Works, Toronto, ON.
authors.forename: Leah S
authors.initials: LS
authors.lastname: Steele
authors.affiliation: Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON.
authors.forename: Anna
authors.initials: A
authors.lastname: Durbin
authors.affiliation: Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lin
authors.affiliation: Institute for Clinical Evaluative Sciences, Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON.
authors.forename: J
authors.initials: J
authors.lastname: Charles Victor
authors.affiliation: Senior Manager, Surveillance, Cancer Care Ontario, Toronto, ON.
authors.forename: Julie
authors.initials: J
authors.lastname: Klein-Geltink
authors.affiliation: Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
authors.affiliation: Institute of Health Policy Management & Evaluation.
authors.forename: Brandon
authors.initials: B
authors.lastname: Zagorski
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kopp
mesh_terms: D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008962:Models, Theoretical; D015999:Multivariate Analysis; D009864:Ontario; D011320:Primary Health Care