Assessing the effects of physician payment on treatment of mental disorders in primary care

Pincus, Harold Alan

doi:10.1016/0163-8343(90)90034-a

Cited by 15 publications

(4 citation statements)

References 22 publications

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“…Other factors that may be affecting the pattern of psychotropic drug use are changes in the structure of health care delivery and health care reimbursement. 31 In many managed care organizations, the incentives of a capitated system would encourage primary care physicians to maintain responsibility for their patients with mental disorders, treat them efficiently with medications, and not refer them to specialty care. At the same time, managed care patients who are referred for specialty care may be more likely to receive medication treatment by a psychiatrist as the sole form of treatment or may be receiving psychotherapy from other providers.…”

Section: Commentmentioning

confidence: 99%

Prescribing Trends in Psychotropic Medications

Pincus¹,

Tanielian²,

Marcus³

et al. 1998

JAMA

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371

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Context.-Psychotropic medications are widely prescribed, but how new classes of psychotropic medications have affected prescribing patterns has not been well documented. Objective.-To examine changes between 1985 and 1994 (data from 1993 and 1994 were combined) in the prescribing patterns of psychotropic medications by office-based primary care physicians, psychiatrists, and other medical specialists. Design.-National estimates for the number of visits during which a physician prescribed a psychotropic medication based on the National Ambulatory Medical Care Surveys conducted in 1985, 1993, and 1994. Setting.-Office-based physician practices in the United States. Participants.-A systematically sampled group of office-based physicians. Main Outcome Measures.-National estimates of visits that included a psychotropic medication. Results.-The number of visits during which a psychotropic medication was prescribed increased from 32.73 million to 45.64 million; the proportion of such visits, as a proportion of all visits, increased from 5.1% to 6.5% (PՅ.01). Antianxiety or hypnotic drug visits, previously the largest category, decreased as a proportion of psychotropic drug visits (PՅ.01) and are now surpassed by antidepressant visits. Visits for depression increased from 10.99 million in 1988 to 20.43 million in 1993 and 1994 (PՅ.01). Stimulant drug visits increased from 0.57 million to 2.86 million (PՅ.01). Although visits for depression doubled for both primary care physicians and psychiatrists, the proportion of visits for depression during which an antidepressant was prescribed increased for psychiatrists but not for primary care physicians. Conclusions.-The patterns of psychotropic medication use in outpatient medical practice changed dramatically during the study period, especially in psychiatric practice.

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Section: Commentmentioning

confidence: 99%

Prescribing Trends in Psychotropic Medications

Pincus¹,

Tanielian²,

Marcus³

et al. 1998

JAMA

Self Cite

371

View full text Add to dashboard Cite

show abstract

“…& Health, Vol. 15, Spring, 1997 in primary care (Pincus, 1990). The most basic distinction is between fee-for-service, capitated, and salaried clinicians.…”

Section: Capitation Managed Care Gatekeepingmentioning

confidence: 99%

“…Although we can expect these natural experiments eventually to produce voluminous data, at this time there is much more conjecture and hypothesis than knowledge about the effects of variations in the organization of services. The first task is to outline some of the most salient variations in the organization of services and incentives, and describe their effects on the provision of mental health services in primary care (Pincus, 1990). The most basic distinction is between fee-for-service, capitated, and salaried clinicians.…”

Section: Adequacy Of Mental Health Servicesmentioning

confidence: 99%

Mental healthcare in the primary care setting: A paradigm problem.

deGruy¹

1997

Families, Systems, & Health

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In this article, I make the case that a major portion of mental healthcare is rendered in the primary care setting, and always will be, sometimes despite strong disincentives; that a sensible vision of primary healthcare must have mental healthcare woven into its fabric; that the primary care setting is well suited to the provision of most mental health services; that despite suboptimal recognition and management of mental disorders and attention to mental health, the structure and operation of primary care can be modified so as to greatly augment the provision of these services; and that the current efforts underway in the US to reform the healthcare system offer an opportunity to find the most effective of these modifications, and to discover fruitful collaborative structures both within the primary care setting and between primary care clinicians and mental health professionals.

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“…PCP/MH provider collaboration may be associated with more timely MH care, where treatment is in more appropriate, yet less intensive and less expensive care settings (Sharfstein and Katz-Levy, 1984). More timely care may avert direct and indirect costs of psychiatric morbidity and mortality, and reduce expenses for general medical care (Jones and Vischi, 1987; Pincus, 1984; Pincus, 1990; Richman, 1990; Shuster, 1992). Savings have been reported from treatment in less intensive mental health settings, such as those found in health maintenance organizations, where MH costs have been found to be lower (Diehr et al, 1984; Norquist and Wells, 1991; Shadle and Christiansen, 1988; Shadle and Christiansen, 1989; Wells et al, 1986).…”

Section: Dimensions Of Pcp/mh Linkagementioning

confidence: 99%

Linkages between primary care physicians and mental health specialists.

Yuen

Gerdes²,

Waldfogel³

1999

Families, Systems, & Health

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Primary care physicians (PCPs) are integral to the provision of mental health (MH) services. Linkages between PCPs and MHproviders are a vital component of care for psychiatric patients. This paper reports on an exploratory survey of PCPs about their relationships with mental health specialists. PCPs affiliated with Jefferson Medical College in Philadelphia, Pennsylvania were surveyed on the nature and quality of consultation and referral practices they had with individual mental health providers and mental health carve-out organizations. The survey was based on published literature regarding collaboration in healthrelated and non health-related organizational settings. Ninety-nine attending physicians responded to the survey. Physicians'ability to treat MH patients was positively related to the availability of MH consultation (p=.O29). 48.5% of PCPs reported never/ seldom providing information to MH carveouts, compared to 16.2% to individual MH providers (p-.OOl). Receipt of patient information back from MH providers was poor-54.4% reported never / seldom receiving information back from MHcarveouts, compared to 47.

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Assessing the effects of physician payment on treatment of mental disorders in primary care

Cited by 15 publications

References 22 publications

Prescribing Trends in Psychotropic Medications

Prescribing Trends in Psychotropic Medications

Mental healthcare in the primary care setting: A paradigm problem.

Linkages between primary care physicians and mental health specialists.

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