Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based study
Objective To examine physician factors associated with practice-level uptake of virtual mental healthcare for children and adolescents.Design, setting and participants A population-based data linkage study of a cohort of all physicians (n=12 054) providing outpatient mental healthcare to children an...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/7/e070172.full |
| _version_ | 1797745773322960896 |
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| author | Paul Kurdyak Simone Vigod Rachel Strauss Astrid Guttmann Eyal Cohen Natasha Ruth Saunders Jun Guan Therese A Stukel Alene Toulany Longdi Fu |
| author_facet | Paul Kurdyak Simone Vigod Rachel Strauss Astrid Guttmann Eyal Cohen Natasha Ruth Saunders Jun Guan Therese A Stukel Alene Toulany Longdi Fu |
| author_sort | Paul Kurdyak |
| collection | DOAJ |
| description | Objective To examine physician factors associated with practice-level uptake of virtual mental healthcare for children and adolescents.Design, setting and participants 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.Main outcomes 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. |
| first_indexed | 2024-03-12T15:27:49Z |
| format | Article |
| id | doaj.art-acf8f92cea4848d485d69dc87f7fabb5 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-12T15:27:49Z |
| publishDate | 2023-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-acf8f92cea4848d485d69dc87f7fabb52023-08-10T11:20:07ZengBMJ Publishing GroupBMJ Open2044-60552023-07-0113710.1136/bmjopen-2022-070172Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based studyPaul Kurdyak0Simone Vigod1Rachel Strauss2Astrid Guttmann3Eyal Cohen4Natasha Ruth Saunders5Jun Guan6Therese A Stukel7Alene Toulany8Longdi Fu9Department of Psychiatry, University of Toronto, Toronto, Ontario, CanadaInsitute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, CanadaICES, Toronto, Ontario, CanadaDepartment of Pediatrics, University of Toronto, Toronto, Ontario, CanadaICES, Toronto, Ontario, CanadaDepartment of Pediatrics, University of Toronto, Toronto, Ontario, CanadaICES, Toronto, Ontario, CanadaICES, Toronto, Ontario, CanadaDepartment of Pediatrics, University of Toronto, Toronto, Ontario, CanadaICES, Toronto, Ontario, CanadaObjective To examine physician factors associated with practice-level uptake of virtual mental healthcare for children and adolescents.Design, setting and participants 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.Main outcomes 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.https://bmjopen.bmj.com/content/13/7/e070172.full |
| spellingShingle | Paul Kurdyak Simone Vigod Rachel Strauss Astrid Guttmann Eyal Cohen Natasha Ruth Saunders Jun Guan Therese A Stukel Alene Toulany Longdi Fu Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based study BMJ Open |
| title | Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based study |
| title_full | Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based study |
| title_fullStr | Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based study |
| title_full_unstemmed | Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based study |
| title_short | Association between physician characteristics and practice-level uptake of paediatric virtual mental healthcare: a population-based study |
| title_sort | association between physician characteristics and practice level uptake of paediatric virtual mental healthcare a population based study |
| url | https://bmjopen.bmj.com/content/13/7/e070172.full |
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