Abstract
Background/Aims The majority of patients with mental health concerns turn to their primary care physician (PCP). We investigate whether periodic health exams (PHEs) may be a good opportunity for these patients to receive mental health services. We examine the impact of patients’ need for mental health care, competing demands from biomedical issues, and the availability of behavioral health providers on the probability of discussing mental health.
Methods The study uses audio recordings of 308 unique patients’ PHEs with 59 PCPs. Visits took place in 22 clinics of an integrated delivery system in metropolitan Detroit between 2007–2009. Administrative data and electronic medical records spanning 12-months before the PHE are also used. Patients are aged 50 to 80; all were deemed to be potentially in need of mental health services because of their Personal Health Questionnaire (PHQ2) score, prior diagnosis of mental illnesses, use of behavioral health services, or psychotropic medication use. We coded the audio to capture visit contents and time spent on each “topic” (defined as an issue that had at least two complete exchanges between patient and physician). We examined the probability of a mental health discussion using a logit generalized estimating equation (GEE) regression.
Results The median length of patient-physician interaction was 26 minutes. The median number of “topics” was 19. Biomedical discussions were present in all visits; 38% (118 of 308) of the visits included a mental health discussion. The median length of a mental health discussion was 47 seconds. Logit results suggest the likelihood of mental health discussion increased if the patient had a PHQ2 =3 (odds ratio [OR]=5.30, p<0.01), was on psychotropic medication (OR=2.47, p<0.05), had a mental health diagnosis in prior year (OR=2.52, p<0.05), and was female (OR=1.88, p<0.05). The likelihood decreased if the clinic has co-located behavioral health (OR=0.47, p<0.05). Percent time spent on biomedical issues did not significantly impact the probability of a mental health discussion.
Conclusions Many discussions occurred during PHEs with patients potentially needing mental health care. Only 38% (118 of 308) of all visits contained mental health discussions, and in those that did more than half lasted less than a minute.
