Thesis Format
Integrated Article
Degree
Master of Science
Program
Epidemiology and Biostatistics
Supervisor
Some, Nibene
2nd Supervisor
Sarma, Sisira
Co-Supervisor
Abstract
Interprofessional team-based primary care practices like Family Health Teams (FHTs) can improve access to care, but their effect on mental health (MH) service utilization is unclear — particularly following the introduction of virtual care billing codes in Ontario. The objectives of this thesis were to: (1) review the literature on the association between team-based care and healthcare utilization among people with MH disorders, and (2) assess the impacts of virtual service codes and team-based care on MH service utilization. The review found that team-based care is likely associated with decreases in all-cause hospitalizations and ED visits among people with MH disorders. Implementation of virtual care was associated with increases in virtual MH services in FHTs and in non-FHTs; however, the impact was greater in FHTs which may indicate that they adapted more rapidly to the use of virtual care.
Summary for Lay Audience
Primary care physicians often have the option to practice in interprofessional teams such as Family Health Teams (FHTs), where they work together with healthcare professionals from various clinical fields to provide healthcare services to patients. These collaborative efforts have been shown to improve patients’ ability to access and use primary healthcare services, such as visiting their family physician for a check-up.
In Ontario, physicians are paid in part by billing the Ministry of Health (MOH) for every healthcare service they provide to patients. These claims include different billing codes, corresponding to each unique service and its price. Prior to COVID-19, most healthcare services were provided in-person. As a result of the pandemic, however, many in-person primary care services were forced to stop. Consequently, the MOH approved new billing codes that allowed physicians to provide virtual services (conducted via phone or video call) in place of usual in-person services.
Mental health (MH) is an important element of overall wellbeing, and MH disorders are commonly associated with increased healthcare utilization. Interprofessional care can improve access to in-person MH services, and is likely associated with decreases in all-cause emergency department visits and hospitalizations among patients with MH disorders. Given that virtual care seems to be a viable alternative to in-person care for MH services, the implementation of these virtual care codes may have affected physicians’ delivery of MH care services differently in teams and non-teams.
To assess the impacts of virtual codes and team-based care on MH service utilization by enrolled patients in Ontario, we analyzed MH services from health administrative databases over seven years (2015–2022). Physicians who were practicing in FHTs were compared to physicians practicing in non-FHTs. The introduction of virtual care codes was associated with an increased number and value of virtual MH services in both practice types; however, the effect was larger for FHTs compared to non-FHTs. This difference may indicate that FHTs adapted more rapidly to the use of virtual care than non-FHTs.
Recommended Citation
Rajaratnam, Ethan, "Interprofessional Team-Based Primary Care Practice and Healthcare Utilization for Mental Health and Substance Use" (2024). Electronic Thesis and Dissertation Repository. 10149.
https://ir.lib.uwo.ca/etd/10149