Trends in office-based mental health care provided by psychiatrists and primary care physicians

Mark Olfson, Kurt Kroenke, Shuai Wang, Carlos Blanco

Research output: Contribution to journalArticle

77 Citations (Scopus)

Abstract

Objective:To assess recent national trends in mental health care provided by office-based psychiatrists and primary care physicians. Method:Trends in mental health-related visits to psychiatrists and primary care physicians are evaluated with the 1995-2010 National Ambulatory Medical Care Surveys. Rates and percentages of visits with mental health complaints, mental disorder diagnoses, psychotropic medications, and psychotherapy or mental health counseling were calculated for 1995-1998,1999-2002,2003-2006, and 2007-2010 by dividing the number of visits of a given type by intercensal population estimates. Results: Between 1995-1998 and 2007-2010, a significant increase occurred in the rate per 100 population of primary care visits with mental health complaints (5.96 to 8.49) (OR = 0.45; 95% Cl, 0.33-0.62, mental disorders (8.75 to 13.23) (OR= 1.40; 95% Cl, 1.26-1.56), and psychotropic medications (11.08 to 26.74) (OR=3.43; 95% Cl, 2.16-2.71). Significant corresponding increases occurred in psychiatrist visits with psychotropic medications (5.28 to 7.85) (OR = 2.25; 95% Cl, 1.49-3.41), but not mental disorders (7.60 to 8.95) (OR = 0.87; 95% Cl, 0.34-2.23), and the rate with mental health complaints significantly declined (5.87 to 5.20) (OR = 0.45; 95% Cl, 0.33-0.62). During this period, the percentages of visits to primary care physicians that included prescriptions for antidepressants (interaction P=.0001), antipsychotics (interaction P=.O3), and anxiolytics/hypnotics (interaction P=.0009) increased significantly faster than the corresponding percentages of visits to psychiatrists. A similar pattern occurred for visits that resulted in a bipolar disorder diagnosis (interaction P=.01). Conclusions: In recent years, office-based primary care physicians have significantly increased their involvement in providing mental health care. These trends underscore the importance of collaboration between primary care physicians and psychiatrists to help ensure provision of high quality outpatient mental health care.

Original languageEnglish (US)
Pages (from-to)247-253
Number of pages7
JournalJournal of Clinical Psychiatry
Volume75
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

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Primary Care Physicians
Psychiatry
Mental Health
Delivery of Health Care
Mental Disorders
Health Care Surveys
Psychiatrists
Primary Care
Healthcare
Physicians
Anti-Anxiety Agents
Hypnotics and Sedatives
Bipolar Disorder
Psychotherapy
Antidepressive Agents
Antipsychotic Agents
Population
Prescriptions
Counseling
Primary Health Care

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Arts and Humanities (miscellaneous)

Cite this

Trends in office-based mental health care provided by psychiatrists and primary care physicians. / Olfson, Mark; Kroenke, Kurt; Wang, Shuai; Blanco, Carlos.

In: Journal of Clinical Psychiatry, Vol. 75, No. 3, 2014, p. 247-253.

Research output: Contribution to journalArticle

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abstract = "Objective:To assess recent national trends in mental health care provided by office-based psychiatrists and primary care physicians. Method:Trends in mental health-related visits to psychiatrists and primary care physicians are evaluated with the 1995-2010 National Ambulatory Medical Care Surveys. Rates and percentages of visits with mental health complaints, mental disorder diagnoses, psychotropic medications, and psychotherapy or mental health counseling were calculated for 1995-1998,1999-2002,2003-2006, and 2007-2010 by dividing the number of visits of a given type by intercensal population estimates. Results: Between 1995-1998 and 2007-2010, a significant increase occurred in the rate per 100 population of primary care visits with mental health complaints (5.96 to 8.49) (OR = 0.45; 95{\%} Cl, 0.33-0.62, mental disorders (8.75 to 13.23) (OR= 1.40; 95{\%} Cl, 1.26-1.56), and psychotropic medications (11.08 to 26.74) (OR=3.43; 95{\%} Cl, 2.16-2.71). Significant corresponding increases occurred in psychiatrist visits with psychotropic medications (5.28 to 7.85) (OR = 2.25; 95{\%} Cl, 1.49-3.41), but not mental disorders (7.60 to 8.95) (OR = 0.87; 95{\%} Cl, 0.34-2.23), and the rate with mental health complaints significantly declined (5.87 to 5.20) (OR = 0.45; 95{\%} Cl, 0.33-0.62). During this period, the percentages of visits to primary care physicians that included prescriptions for antidepressants (interaction P=.0001), antipsychotics (interaction P=.O3), and anxiolytics/hypnotics (interaction P=.0009) increased significantly faster than the corresponding percentages of visits to psychiatrists. A similar pattern occurred for visits that resulted in a bipolar disorder diagnosis (interaction P=.01). Conclusions: In recent years, office-based primary care physicians have significantly increased their involvement in providing mental health care. These trends underscore the importance of collaboration between primary care physicians and psychiatrists to help ensure provision of high quality outpatient mental health care.",
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N2 - Objective:To assess recent national trends in mental health care provided by office-based psychiatrists and primary care physicians. Method:Trends in mental health-related visits to psychiatrists and primary care physicians are evaluated with the 1995-2010 National Ambulatory Medical Care Surveys. Rates and percentages of visits with mental health complaints, mental disorder diagnoses, psychotropic medications, and psychotherapy or mental health counseling were calculated for 1995-1998,1999-2002,2003-2006, and 2007-2010 by dividing the number of visits of a given type by intercensal population estimates. Results: Between 1995-1998 and 2007-2010, a significant increase occurred in the rate per 100 population of primary care visits with mental health complaints (5.96 to 8.49) (OR = 0.45; 95% Cl, 0.33-0.62, mental disorders (8.75 to 13.23) (OR= 1.40; 95% Cl, 1.26-1.56), and psychotropic medications (11.08 to 26.74) (OR=3.43; 95% Cl, 2.16-2.71). Significant corresponding increases occurred in psychiatrist visits with psychotropic medications (5.28 to 7.85) (OR = 2.25; 95% Cl, 1.49-3.41), but not mental disorders (7.60 to 8.95) (OR = 0.87; 95% Cl, 0.34-2.23), and the rate with mental health complaints significantly declined (5.87 to 5.20) (OR = 0.45; 95% Cl, 0.33-0.62). During this period, the percentages of visits to primary care physicians that included prescriptions for antidepressants (interaction P=.0001), antipsychotics (interaction P=.O3), and anxiolytics/hypnotics (interaction P=.0009) increased significantly faster than the corresponding percentages of visits to psychiatrists. A similar pattern occurred for visits that resulted in a bipolar disorder diagnosis (interaction P=.01). Conclusions: In recent years, office-based primary care physicians have significantly increased their involvement in providing mental health care. These trends underscore the importance of collaboration between primary care physicians and psychiatrists to help ensure provision of high quality outpatient mental health care.

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