270396 Mental health discussion during annual physicals: Less than half have it and for less than one minute

Monday, October 29, 2012

Ming Tai-Seale, PhD , Health Policy Research Department, Palo Alto Medical Foundation, Mountain View, CA
Thomas McGuire, PhD , Department of Health Care Policy, Harvard Medical School, Boston, MA
Caroline Wilson, MS , Health Policy Research Department, Palo Alto Medical Foundation, Mountain View, CA
Richard Frankel, PhD , Veterans Administration Medical Center, Indianapolis, IN
Cheryl Stults, PhD , Health Policy Research Department, Palo Alto Medical Foundation, Mountain View, CA
Ashley Stone, MPH , Health Policy Research Department, Palo Alto Medical Foundation, Mountain View, CA
Lisa Diamond, MD, MPH , Department of Psychiatry and Behavioral Health, Memorial Sloan-Kettering Cancer Center, New York, NY
Lisa Maclean, MD , Student Affairs, Wayne State University School of Medicine, Detroit, MI
Jennifer Elston Lafata, PhD , Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI
Most patients with mental health (MH) concerns turn to their primary care physicians (PCPs). We investigate whether annual physicals are a good opportunity for these patients to receive or initiate MH services. The study uses audio recordings of checkups for 322 patients potentially in need of MH services. We examined the probability of a MH discussion using a logit generalized estimating equation (GEE) regression, followed by analysis of the cumulative share of time allocated to MH across the cumulative share of PHQ2 scores in the sample. Only 38% of the visits included a MH discussion. The median length of a MH discussion was 47 seconds. Logit results suggest the likelihood of MH 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 MH 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 services (OR=0.47, p<0.05). Patients with the bottom 20% of PHQ2 scores (least depressed) had about 46% of the cumulative time spent on MH. Patients with the next 60% of scores took the next 29% of MH time, leaving the 20% patients with the highest scores (most depressed) having 25% of MH time. Even though annual physicals were designed for comprehensive care, the time distribution does not match with patients' MH needs. The value of annual physicals may need to be enhanced by better integration of MH services to ensure integrated care for patients in need.

Learning Areas:
Provision of health care to the public

Learning Objectives:
∑ Identify the factors influencing the likelihood of a mental health discussion taking place during annual checkups ∑ Discuss the role of annual physicals in meeting patientsí mental health needs, and the barriers to mental health discussions taking place

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a senior investigator at the Palo Alto Medical Foundation's Research Institute and was a Professor of Health Economics at Texas A&M School of Rural Public Health. I am principal investigator on a research project "Mental Health Communication in Elderly Primary Care Visits and Economic Outcomes" which is funded by the National Institute of Mental Health (R01MH081098). My other research projects have been funded by NIMH and AHRQ.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.