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Explore the state of psychiatry in Ontario, focusing on access, care transitions, and psychiatrist supply. Addressing issues through evidence-based strategies for better mental health services.
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Psychiatry in Ontario:Current Evidence and Future StateAGHPS Leadership Summit 2018 Paul Kurdyak MD PhD Scientist, Institute for Mental Health Policy Research, CAMH Core Senior Scientist and Program Lead, Mental Health and Addictions Program Institute for Clinical Evaluative Sciences Associate Professor, IHPME
Disclosures • No conflicts of interest • Funding from: • CIHR • MOHTLC
Objectives • To understand the importance of performance measurement to address issues related to health service quality. • To learn about recent research describing access to mental health care amongst certain patient populations. • To learn about emerging evidence describing different mental health service delivery models.
First Episode Psychosis – Access to Care • 20,096 with FEP between 1999 and 2008 • Approximately 40 per cent did not receive any physician follow-up within 30 days • Nearly 60 per cent did not receive follow-up by a psychiatrist • Males had lower odds of receiving any physician follow-up. • The odds of psychiatrist follow-up decreased with increasing age and were lower for those living in rural areas.
Early Intervention and MortalityAnderson et al., Am J Psychiatry. 2018 May 1;175(5):443-452
Substance Use and ED use • 1 out of 15 frequent ED users is for Mental Health/Addictions • 64% of frequenty MHA ED users have substance-related issues
Shifting Gears • Overview of previous slides: • Indirect evidence that access to outpatient services is inadequate and transitions of care from the ED and hospitalizations to outpatients is poor • What do we know about psychiatrist supply and practice patterns?
What about incentives? • In September, 2011, MOHLTC introduced bonus payments for: • Rapid access to patients within 30 days of psychiatric hospitalization discharge • Ongoing care for 6 months following a suicide attempt • Stated objective – to increase access at a critical period of time that would reduce deterioration, early readmission and possibly suicide attempts • We can identify individuals post-discharge AND post-suicide attempt (ED only)
A long list of issues Access to care is problematic There is evidence that the people with the greatest need are least likely to get the care they need There are concerning trends in regional psychiatrist supply that will make access worse
What evidence exists to move forward? Measurement-based care Integrated Care VERY little evidence on how to achieve good outcomes (medical and psychiatric) for individuals with serious mental illnesses
Psychiatric Services, Feb. 2017; 68(2):179-188 • 18% of US psychiatrists and 11% of US psychologists routinely incorporate symptom rating scales into their practice • BUT MH providers MISS clinical deterioration in 80% of their patients • Systematic review conclusions – ALL RCTs showed frequent and timely feedback of patient-reported symptoms during pharmaco- or psychotherapy improved patient outcomes
Conclusions Emerging evidence that access and transitions in care are problematic Existing psychiatrist supply and practice patterns will not address access and transition evidence without change Evidence exists, but is not being implemented in Ontario
Thank you! Questions?