1 Institute for Clinical Evaluative Sciences, Toronto, Ontario.
2 Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario.
Can J Psychiatry. 2018 Feb;63(2):94-102. doi: 10.1177/0706743717748926. Epub 2018 Jan 1.
Although evidence suggests that treatment seeking for mental illness has increased over time, little is known about how the health system is meeting the increasing demand for services. We examined trends in physician-based mental health service use across multiple sectors.
In this population-based study, we used linked health-administrative databases to measure annual rates of mental health-related outpatient physician visits to family physicians and psychiatrists, emergency department visits, and hospitalizations in adults aged 16+ from 2006 to 2014. We examined absolute and relative changes in visit rates, number of patients, and frequency of visits per patient, and assessed temporal trends using linear regressions.
Among approximately 11 million Ontario adults, age- and sex-standardized rates of mental health-related outpatient physician visits declined from 604.8 to 565.5 per 1000 population over the study period ( P = 0.04). Over time, the rate of visits to family physicians/general practitioners remained stable ( P = 0.12); the number of individuals served decreased, but the number of visits per patient increased. The rate of visits to psychiatrists declined ( P < 0.001); the number of individuals served increased, but the number of visits per patient decreased. Concurrently, visit rates to emergency departments and hospitals increased (16.1 to 19.7, P < 0.001 and 5.6 to 6.0, P = 0.01, per 1000 population, respectively). Increases in acute care service use were greatest for anxiety and addictions.
The increasing acute care service use coupled with the reduction in outpatient visits suggest, overall, an increase in demand for mental health care that is not being met in ambulatory care settings.
尽管有证据表明，寻求精神疾病治疗的人数随着时间的推移而增加，但对于卫生系统如何满足不断增长的服务需求知之甚少。我们研究了多个部门基于医生的心理健康服务使用的趋势。
在这项基于人群的研究中，我们使用链接的健康管理数据库来衡量 2006 年至 2014 年期间，16 岁及以上成年人中与心理健康相关的家庭医生和精神科医生门诊就诊率、急诊就诊率和住院率的年度变化。我们考察了就诊率、就诊人数和每位患者就诊频率的绝对和相对变化，并使用线性回归评估了时间趋势。
在大约 1100 万安大略省成年人中，与心理健康相关的门诊医生就诊率从研究期间的每 1000 人 604.8 次标准化为年龄和性别标准化后下降到 565.5 次（P = 0.04）。随着时间的推移，家庭医生/全科医生的就诊率保持稳定（P = 0.12）；就诊人数减少，但每位患者的就诊次数增加。精神科医生的就诊率下降（P < 0.001）；就诊人数增加，但每位患者的就诊次数减少。同时，急诊和医院就诊率增加（每 1000 人分别增加 16.1 次和 19.7 次，P < 0.001 和 5.6 次和 6.0 次，P = 0.01）。焦虑和成瘾的急性护理服务使用增加幅度最大。
急性护理服务使用的增加加上门诊就诊次数的减少表明，总体上，对精神保健的需求增加，而在非住院环境中无法满足这一需求。
