Citation

Rudoler D, de Oliveira C, Cheng J, Kurdyak P. CMAJ 2017; 189(49): E1509-E1516.

Affiliation

Institute for Mental Health Policy Research (Rudoler, de Oliveira, Cheng, Kurdyak), Centre for Addiction and Mental Health; Mental Health and Addictions Research Program (Rudoler, de Oliveira, Cheng, Kurdyak), Institute for Clinical Evaluative Sciences; Department of Psychiatry, Faculty of Medicine (Kurdyak) and Institute of Health Policy, Management and Evaluation (Rudoler, de Oliveira, Cheng), University of Toronto, Toronto, Ont.

Copyright

(Copyright © 2017, Canadian Medical Association)

DOI

10.1503/cmaj.160816

PMID

29229712

Abstract

BACKGROUND: In September 2011, the government of Ontario implemented payment incentives to encourage the delivery of community-based psychiatric care to patients after discharge from a psychiatric hospital admission and to those with a recent suicide attempt. We evaluated whether these incentives affected supply of psychiatric services and access to care.

METHODS: We used administrative data to capture monthly observations for all psychiatrists who practised in Ontario between September 2009 and August 2014. We conducted interrupted time-series analyses of psychiatrist-level and patient-level data to evaluate whether the incentives affected the quantity of eligible outpatient services delivered and the likelihood of receiving follow-up care.

RESULTS: Among 1921 psychiatrists evaluated, implementation of the incentive payments was not associated with increased provision of follow-up visits after discharge from a psychiatric hospital admission (mean change in visits per month per psychiatrist 0.0099, 95% confidence interval [CI] -0.0989 to 0.1206; change in trend 0.0032, 95% CI -0.0035 to 0.0095) or after a suicide attempt (mean change -0.0910, 95% CI -0.1885 to 0.0026; change in trend 0.0102, 95% CI 0.0045 to 0.0159). There was also no change in the probability that patients received follow-up care after discharge (change in level -0.0079, 95% CI -0.0223 to 0.0061; change in trend 0.0007, 95% CI -0.0003 to 0.0016) or after a suicide attempt (change in level 0.0074, 95% CI -0.0094 to 0.0366; change in trend 0.0006, 95% CI -0.0007 to 0.0022).

INTERPRETATION: Our results suggest that implementation of the incentives did not increase access to follow-up care for patients after discharge from a psychiatric hospital admission or after a suicide attempt, and the incentives had no effect on supply of psychiatric services. Further research to guide design and implementation of more effective incentives is warranted.

© 2017 Joule Inc. or its licensors.

Language: en