Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based study.
BMJ Open
; 13(7): e070172, 2023 07 14.
Article
em En
| MEDLINE
| ID: mdl-37451721
ABSTRACT
OBJECTIVE:
To examine physician factors associated with practice-level uptake of virtual mental healthcare for children and adolescents. DESIGN, SETTING ANDPARTICIPANTS:
A population-based data linkage study of a cohort of all physicians (n=12 054) providing outpatient mental healthcare to children and adolescents (aged 3-17 years, n=303 185) in a single-payer provincial health system in Ontario, Canada from 1 July 2020 to 31 July 2021. EXPOSURES Physician characteristics including gender, age, specialty, location of training, practice region, practice size and overall and mental health practice size. MAINOUTCOMES:
Practice-level proportion of outpatient virtual care provided (1) mostly in-person (<25% virtual care), (2) hybrid (25%-99% virtual care) or (3) exclusively virtual (100% virtual care). Multinomial logistic regression models tested the association between practice-level virtual care provided and physician characteristics.RESULTS:
Among physicians, 1589 (13.2%) provided mostly in-person mental healthcare with 8714 (67.8%) providing hybrid care, and 2291 (19.0%) providing exclusively virtual care. The provision of exclusive virtual care (vs mostly in-person) was associated with female sex (adjusted OR (aOR) 1.97, 95% CI 1.70 to 2.27 (ref male)), foreign training (aOR 1.27, 95% CI 1.07 to 1.50 (ref Canadian-trained)), family physicians (aOR 2.05, 95% CI 1.56 to 2.69 (ref psychiatrist)) and reversely associated with large practice size (aOR 0.32, 95% CI 0.25 to 0.40 (ref smallest quintile)). Mostly in-person care was associated with older age physicians (71+ years) and practice outside the Toronto region. CONCLUSIONS AND RELEVANCE In a single-payer universal healthcare system that remunerates physicians using the same fee structure for in-person and virtual outpatient care, there is heterogeneity in utilisation of virtual care that is associated with provider factors. This practice variation, with limited evidence on effectiveness and appropriate contexts for virtual care use, suggests there may be opportunity for further outcomes research and guidance on appropriate context for paediatric virtual mental healthcare delivery.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Médicos
/
Serviços de Saúde Mental
Tipo de estudo:
Guideline
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Child
/
Female
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article