Periodic health examinations and missed opportunities among patients likely needing mental health care

Ming Tai-Seale, Laura A. Hatfield, Caroline J. Wilson, Cheryl D. Stults, Thomas G. McGuire, Lisa C. Diamond, Richard Frankel, Lisa MacLean, Ashley Stone, Jennifer Elston Lafata

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Periodic health examinations (PHEs) are the most common reason adults see primary care providers. It is unknown if PHEs serve as a "safe portal" for patients with mental health needs to initiate care. We examined how physician communication styles impact mental health service delivery in PHEs. STUDY DESIGN: Retrospective observational study using audio-recordings of 255 PHEs with patients likely to need mental health care. METHODS: Mixed-methods examined the timing of a mental health discussion (MHD), its quality, and the relationship between MHD quality and physician practice styles. MHD quality was measured against evidence-based practices as a 3-level variable (evidence-based, perfunctory, or absent). Physician practice styles were measured by: visit length, verbal dominance, and elicitation of a patient's agenda. A generalized ordered logit model was used. RESULTS: Many patients came with mental health concerns, as over 50% of the MHDs occurred in the first 5 minutes of the visit. One-third of the 255 patients had an evidencebased MHD, another third had a perfunctory MHD, and the remaining had no MHD. MHD quality was significantly associated with physician communication styles. Visits with physicians who tend to spend more time with patients, fully elicit patients' agendas, and let patients talk (instead of being verbally dominant) were more likely to deliver evidence-based MHD. CONCLUSIONS: If done well, PHEs could be a safe portal for patients to seek mental health care, but most PHEs fell short. Improving PHE quality may require reimbursement for longer visits and coaching for physicians to more fully elicit patients' agendas and to listen more attentively.

Original languageEnglish (US)
Pages (from-to)e350-e357
JournalAmerican Journal of Managed Care
Volume22
Issue number10
StatePublished - Oct 1 2016

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Mental Health
Delivery of Health Care
Health
Physicians
Communication
Evidence-Based Practice
Mental Health Services
Observational Studies
Primary Health Care
Retrospective Studies
Logistic Models

ASJC Scopus subject areas

  • Health Policy

Cite this

Tai-Seale, M., Hatfield, L. A., Wilson, C. J., Stults, C. D., McGuire, T. G., Diamond, L. C., ... Lafata, J. E. (2016). Periodic health examinations and missed opportunities among patients likely needing mental health care. American Journal of Managed Care, 22(10), e350-e357.

Periodic health examinations and missed opportunities among patients likely needing mental health care. / Tai-Seale, Ming; Hatfield, Laura A.; Wilson, Caroline J.; Stults, Cheryl D.; McGuire, Thomas G.; Diamond, Lisa C.; Frankel, Richard; MacLean, Lisa; Stone, Ashley; Lafata, Jennifer Elston.

In: American Journal of Managed Care, Vol. 22, No. 10, 01.10.2016, p. e350-e357.

Research output: Contribution to journalArticle

Tai-Seale, M, Hatfield, LA, Wilson, CJ, Stults, CD, McGuire, TG, Diamond, LC, Frankel, R, MacLean, L, Stone, A & Lafata, JE 2016, 'Periodic health examinations and missed opportunities among patients likely needing mental health care', American Journal of Managed Care, vol. 22, no. 10, pp. e350-e357.
Tai-Seale M, Hatfield LA, Wilson CJ, Stults CD, McGuire TG, Diamond LC et al. Periodic health examinations and missed opportunities among patients likely needing mental health care. American Journal of Managed Care. 2016 Oct 1;22(10):e350-e357.
Tai-Seale, Ming ; Hatfield, Laura A. ; Wilson, Caroline J. ; Stults, Cheryl D. ; McGuire, Thomas G. ; Diamond, Lisa C. ; Frankel, Richard ; MacLean, Lisa ; Stone, Ashley ; Lafata, Jennifer Elston. / Periodic health examinations and missed opportunities among patients likely needing mental health care. In: American Journal of Managed Care. 2016 ; Vol. 22, No. 10. pp. e350-e357.
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