Assessing Depression Treatment in Primary Care

Project number: 
14-074
Approval date: 
Wednesday, August 6, 2014
Principal Investigator: 
Puyat,Joseph
Institution: 
University of British Columbia (UBC)
Funding Agency: 
not grant funded
Datasets requested: 
consolidation - census geocodes
Deaths (BC Vital Statistics Agency)
Medical Services Plan (BC Ministry of Health)
Consolidation - demographic (Ministry of Health)
Income band (Statistics Canada)
Hospital Separations (BC Ministry of Health)
Consolidation registry (Ministry of Health)
PharmaNet
Mental Health (BC Ministry of Health)
Research objective: 

The research questions that will be addressed in this study are:

1) What is the extent to which individuals receive guideline-based care for MDD and does receipt of guideline-based care for MDD differ by age and sex?

Hypothesis:

As the Canadian primary health care system is probably not fully configured to deliver mental health care and that there are existing barriers to providing guideline-based mental health, we hypothesize that a considerable proportion of people do not receive guideline-based care for MDD and that there are variations by age and sex in the receipt of guideline-based care for MDD.

2) Does having comorbid chronic physical condition influence receipt of MDD guideline-based care among patients diagnosed with MDD?

Hypothesis:

As most family physicians were trained and have more experience in managing physical conditions, we hypothesize that patients with comorbid physical conditions are less likely to received guideline-based care than those without comorbid physical conditions.

3) What is the impact of financial incentives on the delivery of MDD guideline-based care?

Hypothesis:

The existing literature highlight the important of restructuring the way mental health care is delivered in primary care. As BC did not introduce any structural changes we hypothesize that the introduction of financial incentives did not have a sustained impact on the delivery of guideline-based care.

4) What is the impact of introducing physician training modules related to mental health, in addition to financial incentives, on the delivery of MDD guideline-based care?

Hypothesis:

We hypothesize that the introduction of financial incentives and physician training modules decreased the initiation rates and treatment duration for antidepressants.

Publications: 

Journal Publication

  • Puyat JH, Kazanjian A, Wong H, Goldner E. Comorbid Chronic General Health Conditions and Depression Care: A Population-Based Analysis. PS. 2017 May 1;appi.ps.201600309.
  • Puyat JH, Kazanjian A, Wong H, Goldner EM. Is the Road to Mental Health Paved With Good Incentives? Estimating the Population Impact of Physician Incentives on Mental Health Care Using Linked Administrative Data. Med Care. 2017 Feb;55(2):182โ€“90.
  • Puyat JH, Kazanjian A, Goldner EM, Wong H. How Often Do Individuals with Major Depression Receive Minimally Adequate Treatment? A Population-Based, Data Linkage Study. Can J Psychiatry. 2016 Jul 1;61(7):394โ€“404.

Conference abstract/presentation

  • Puyat JH, Kazanjian A. Can physician incentives improve continuity of care for patients receiving depression treatment in the primary care setting? European Psychiatry. 2016 Mar;33, Supplement:S481.
  • Puyat JH, Kazanjian A. More women are medicated while more men are talked out: Persistent gender disparities in mental health care. European Psychiatry. 2016 Mar;33, Supplement:S449โ€“50.
  • Puyat J, Kazanjian A. Do Individuals with Depression and Comorbid Medical Conditions Receive Poorer Mental Health Care than those with Depression Alone? International Journal for Population Data Science [Internet]. 2017 Apr 19 [cited 2017 Apr 25];1(1). Available from: https://ijpds.org/article/view/390
  • Puyat JH, Kazanjian AK, Wong H, Goldner EM. The impact of physician incentives on the provision of mental health care: a data linkage, interrupted time series analysis. Canadian Academy of Psychiatric Epidemiology. Vancouver, September 30, 2015. Poster.
  • Puyat JH, Kazanjian AK, Goldner EM, Wong H. Improving access to minimally adequate counseling/psychotherapy through financial incentives: Did British Columbia get it right? Annual CAHSPR Conference, Montreal, QC, May 26-28, 2015. Oral.
  • Puyat JH, Kazanjian AK, Goldner EM, Wong H. Do British Columbians with major depression receive minimally adequate care? Annual CAHSPR Conference, Montreal, QC, May 26-28, 2015. Poster.
  • Puyat JH, Kazanjian A, Wong H, Goldner EM. The Mental Health Care Patterns of Individuals Who Receive Counseling or Psychotherapy During the First 12 Weeks of Treatment for Major Depressive Episode. European Psychiatry. 2015 Mar 28;30:1372.

Page last revised: December 5, 2017