Article Figures & Tables
Tables
Characteristic No. (%) of physicians* SDiff† No. (%) of physicians* SDiff† PCP psychotherapists
n = 404PCP nonpsychotherapists
n = 12 368Psychiatrist psychotherapist
n = 586Psychiatrist nonpsychotherapist
n = 1564Female sex 206 (51.0) 5712 (46.2) 0.10 239 (40.8) 659 (42.1) 0.03 Age category, yr < 30 0 (0.0) 136 (1.1) 0.15 0 (0.0) 0 (0.0) – 30–39 24 (5.9) 2173 (17.6) 0.37 16 (2.7) 208 (13.3) 0.40 40–49 47 (11.6) 2628 (21.2) 0.26 49 (8.4) 386 (24.7) 0.45 50–59 121 (30.0) 3038 (24.6) 0.12 146 (24.9) 372 (23.8) 0.03 ≥ 60 204 (50.5) 2992 (24.2) 0.57 367 (62.6) 443 (28.3) 0.73 Missing 8 (2.0) 1401 (11.3) 0.38 8 (1.4) 155 (9.9) 0.38 Age, yr, mean ± SD 59.8 ± 11.5 51.2 ± 12.3 0.73 63.0 ± 11.0 52.9 ± 11.8 0.88 Full-time 218 (54.0) 8721 (70.5) 0.35 417 (71.2) 1088 (69.6) 0.03 Medical school University of Toronto 115 (28.5) 2615 (21.1) 0.17 148 (25.3) 185 (11.8) 0.35 University of Ottawa 34 (8.4) 914 (7.4) 0.04 23 (3.9) 82 (5.2) 0.06 Queen’s University 25 (6.2) 656 (5.3) 0.04 17 (2.9) 82 (5.2) 0.12 McMaster University 65 (16.1) 1104 (8.9) 0.22 47 (8.0) 145 (9.3) 0.04 Western University 38 (9.4) 1140 (9.2) 0.01 31 (5.3) 76 (4.9) 0.02 Northern Ontario 0 (0.0) 74 (0.6) 0.11 0 (0.0) 0 (0.0) – Other Canadian 60 (14.8) 1433 (11.6) 0.10 138 (23.5) 251 (16.0) 0.19 Non-Canadian 67 (16.6) 4432 (35.8) 0.45 182 (31.1) 743 (47.5) 0.34 LHIN region of practice‡ High supply 178 (44.1) 2951 (23.9) 0.44 401 (68.4) 632 (40.4) 0.59 Medium supply 77 (19.1) 2515 (20.3) 0.03 63 (10.8) 363 (23.2) 0.34 Low supply 149 (36.9) 6901 (55.8) 0.39 122 (20.8) 569 (36.4) 0.35 Missing 0 (0.0) 1 (0.0) – 0 (0.0) 0 (0.0) – Note: LHIN = Local Health Integration Network, PCP = primary care physician, SD = standard deviation, SDiff = standardized difference.
↵* Except where noted otherwise.
↵† A standardized difference of greater than 0.1 is considered clinically significant. (12)
↵‡ Based on whether the per capita supply of psychiatrists is much higher than the provincial average (high supply), at or near the provincial average (medium supply), or below the provincial average (low supply). (9)
Variable PCP psychotherapists
n = 404PCP nonpsychotherapists
n = 12 368SDiff† Psychiatrist psychotherapists
n = 586Psychiatrist nonpsychotherapists
n = 1564SDiff† No. of outpatients Mean (SDiff†) 218.27 (300.20) 1425.64 (1416.39) 1.18 131.76 (165.34) 274.40 (286.26) 0.61 Median (IQR) 105 (48–272) 1118 (604–1732) 1.76 77 (40–165) 189 (87–376) 0.74 No. of new outpatients Mean ± SD 125.12 ± 219.42 869.31 ± 1161.39 0.89 55.74 ± 85.64 162.06 ± 200.36 0.69 Median (IQR) 40 (14–146) 516 (278–939) 1.65 26 (9–69) 107 (41–210) 0.95 Annual no. of visits per outpatient Mean ± SD 8.56 ± 7.50 2.84 ± 2.80 1.01 13.77 ± 12.72 4.22 ± 3.97 1.01 Median (IQR) 7 (4–11) 2 (2–3) 1.31 10 (5–18) 3 (2–5) 1.49 Annual no. of visits per patient, no. (%) of physicians ≤ 3 112 (27.7) 10 792 (87.3) 1.51 77 (13.1) 998 (63.8) 1.22 4–16 244 (60.4) 1475 (11.9) 1.17 340 (58.0) 534 (34.1) 0.49 ≥ 17 48 (11.9) 101 (0.8) 0.47 169 (28.8) 32 (2.0) 0.80 No. of single-visit outpatients, mean (SDiff†) 84.23 (183.55) 772.25 (1051.97) 0.91 31.95 (51.62) 117.78 (158.94) 0.73 < 200 outpatients annually, no. (%) of physicians 275 (68.1) 1383 (11.2) 1.43 478 (81.6) 810 (51.8) 0.67 < 100 outpatients annually, no. (%) of physicians 198 (49.0) 917 (7.4) 1.04 350 (59.7) 441 (28.2) 0.67 < 40 outpatients annually, no. (%) of physicians 79 (19.6) 525 (4.2) 0.49 143 (24.4) 201 (12.8) 0.30 Characteristic No. (%) of patients SDiff† No. (%) of patients SDiff† PCP psychotherapists
n = 95 569PCP nonpsychotherapists
n = 10 600 008Psychiatrist psychotherapists
n = 80 028Psychiatrist nonpsychotherapists
n = 403 929Female sex 55 893 (58.5) 5 743 955 (54.2) 0.09 46 075 (57.6) 217 493 (53.8) 0.08 Age category, yr < 18 9030 (9.4) 1 901 785 (17.9) 0.25 8029 (10.0) 46 044 (11.4) 0.04 18–29 15 675 (16.4) 1 523 601 (14.4) 0.06 12 276 (15.3) 73 738 (18.3) 0.08 30–39 15 213 (15.9) 1 344 577 (12.7) 0.09 11 651 (14.6) 60 516 (15.0) 0.01 40–49 16 578 (17.3) 1 470 261 (13.9) 0.10 13 875 (17.3) 64 414 (15.9) 0.04 50–64 24 838 (26.0) 2 385 287 (22.5) 0.08 24 122 (30.1) 98 124 (24.3) 0.13 > 64 14 235 (14.9) 1 974 497 (18.6) 0.10 10 075 (12.6) 61 093 (15.1) 0.07 Age, yr, mean ± SD 43.7 ± 19.8 42.1 ± 23.1 0.07 43.8 ± 18.4 43.1 ± 20.3 0.04 Immigrant 12 396 (13.0) 1 643 862 (15.5) 0.07 10 776 (13.5) 48 013 (11.9) 0.05 Income quintile 1 (lowest) 17 603 (18.4) 1 903 886 (18.0) 0.01 16 144 (20.2) 96 729 (23.9) 0.09 2 18 224 (19.1) 2 024 154 (19.1) 0.00 14 787 (18.5) 81 261 (20.1) 0.04 3 17 667 (18.5) 2 134 174 (20.1) 0.04 13 970 (17.5) 74 383 (18.4) 0.02 4 19 323 (20.2) 2 331 854 (22.0) 0.04 15 571 (19.5) 75 913 (18.8) 0.02 5 (highest) 22 197 (23.2) 2 150 212 (20.3) 0.07 18 930 (23.7) 72 734 (18.0) 0.14 Missing 555 (0.6) 55 728 (0.5) 0.01 626 (0.8) 2909 (0.7) 0.01 LHIN region High supply 32 946 (34.5) 1 882 733 (17.8) 0.39 33 082 (41.3) 87 269 (21.6) 0.43 Medium supply 17 824 (18.7) 2 203 072 (20.8) 0.05 8448 (10.6) 95 488 (23.6) 0.35 Low supply 44 718 (46.8) 6 500 401 (61.3) 0.29 38 366 (47.9) 220 478 (54.6) 0.13 Missing 81 (0.1) 13 802 (0.1) 0.01 132 (0.2) 694 (0.2) 0.00 Mental health services need MHA hospital admission 4086 (4.3) 81 199 (0.8) 0.23 6713 (8.4) 43 902 (10.9) 0.08 MHA emergency department visit 5819 (6.1) 166 951 (1.6) 0.24 9659 (12.1) 60 503 (15.0) 0.09 ≥ 2 emergency department visits for substance abuse 1168 (1.2) 13 421 (0.1) 0.13 888 (1.1) 5714 (1.4) 0.03 Emergency department visit for self-harm 1149 (1.2) 26 216 (0.2) 0.11 1784 (2.2) 10 648 (2.6) 0.03 Note: IQR = interquartile range, LHIN = Local Health Integration Network, MHA = mental health and addictions, PCP = primary care physician, SD = standard deviation, SDiff = standardized difference.
↵* Includes all billing data for psychotherapists, not just psychotherapy data.
↵† A standardized difference of greater than 0.1 is considered clinically significant. (12)
- Table 4:
Follow-up within 30 and 180 days of index event among patients with urgent need for mental health services, by physician type
Variable Index event, no. (%) of patients MHA hospital admission
n = 96 247MHA emergency department visit
n = 192 641Emergency department visit for self-harm
n = 28 699≥ 2 emergency department visits for substance use
n = 16 022Visit within 30 d of index event* Visit to psychiatrist psychotherapist 3004 (3.1) 4232 (2.2) 835 (2.9) 187 (1.2) Visit to psychiatrist nonpsychotherapist 27 625 (28.7) 44 736 (23.2) 8311 (29.0) 2224 (13.9) Visit to PCP psychotherapist 1969 (2.0) 2443 (1.3) 450 (1.6) 436 (2.7) MHA visit to PCP nonpsychotherapist 26 465 (27.5) 53 565 (27.8) 8098 (28.2) 4658 (29.1) None of the above 47 329 (49.2) 104 563 (54.3) 14 254 (49.7) 9654 (60.2) Visit within 180 d of index event* Visit to psychiatrist psychotherapist 5430 (5.6) 8759 (4.6) 1612 (5.6) 547 (3.4) Visit to psychiatrist nonpsychotherapist 45 694 (47.5) 73 462 (38.1) 12 780 (44.5) 4707 (29.4) Visit to PCP psychotherapist 3835 (4.0) 5372 (2.8) 1016 (3.5) 1153 (7.2) MHA visit to PCP nonpsychotherapist 45 817 (47.6) 92 053 (47.8) 14 492 (50.5) 8655 (54.0) None of the above 27 228 (28.3) 65 470 (34.0) 8367 (29.2) 5553 (34.7) Note: MHA = mental health and addictions, PCP = primary care physician.
↵* Some patients saw more than 1 type of physician.