General practitioners are the primary providers of mental health care for most Canadians. Information on the number of mental health-related consultations that take place with general practitioners is used for different purposes 1,2 , for example to assess compliance with guidelines on follow-up care. The main sources of personal data on primary mental health care visits are surveys, particularly the Canadian Community Health Survey (CCHS): Mental Health and Well-Being (2002, cycle 1.2) 3.4 , as well as provincial administrative health records, which are now used by the Public Health Agency of Canada for national surveillance of “treated” mental health cases. That said, two previous studies 5,6 have shown that, compared to provincial administrative data, survey data produce higher intra-individual estimates of the number of mental health consultations.
Thus, according to one study 5 , the average difference in the number of consultations with a “health professional” to obtain mental health care was 28% higher according to data from the National Population Health Survey of 1994-1995 than in the number of such visits to a “doctor” calculated from Ontario Health Insurance Plan data. However, the study did not establish a direct comparison between the two data sources regarding the number of consultations with a general practitioner regarding mental health status. In addition, it focused on consultations involving mental health “services” ( e.g. psychotherapy) in administrative data and did not take into account those made generally in a general practitioner’s office for reasons related to mental health.
Another method of identifying mental health-related consultations in administrative data relies on diagnostic codes entered to explain the reasons for consultations 7,8 . Using this method (also used for national surveillance purposes), Palin and colleagues 6 compare administrative data from the British Columbia Medical Services Plan for mental health care visits and estimates from the 2002 Canadian Community Health Survey, for a linked sample. Since the CCHS included separate questions on consulting a general
Therefore, this study uses a two-step approach to determine the number of mental health care visits based on administrative data. In the first step, we compared the number of mental health-related consultations that CCHS participants reported having had with the general practitioner consulted most often over the past twelve months to the number of consultations with the primary general practitioner who had a mental disorder diagnosis code in the BC health plan data.
In the second step, CCHS participants’ self-reported data were compared to the total number of primary GP visits from administrative data, regardless of diagnosis. While the self-reported number of consultations with the primary general practitioner for mental health care was greater than the total number of consultations with the primary general practitioner based on administrative data, the discrepancy between the two data sources was not entirely attributable to coding of the diagnosis. These comparisons were made for the total sample and by mental disorder.
Data and methods
Self-reported data come from a subsample of the Canadian Community Health Survey conducted in 2002 (cycle 1.2). This is a cross-sectional survey whose field of observation covered the household population aged 15 and over in the ten provinces, but excluded people living in institutions, residents of Indian reserves, territories and certain remote regions. , as well as members of the regular force of the Canadian Armed Forces and civilians residing on military bases. In order to obtain sufficiently large samples of young and old people, people aged 15 to 24 and 65 and older were oversampled.
The response rate to the CCHS in British Columbia was 77.7%. In the case of the paired sample used for the purposes of the study, 86.2% of the interviews were conducted in person and the remaining proportion by telephone. Detailed information on the sampling design, interview methods and questionnaire have been published elsewhere 3,4 . No proxy interviews were conducted.
Administrative data comes from the British Columbia Medical Services Plan database; This database includes records of payments made to physicians for medical services provided on a fee-for-service basis
Data linkage and sample size
The 2002 CCHS sample for British Columbia included 3,902 participants. The BC Ministry of Health was responsible for linking CCHS data with health plan data for CCHS participants who consented and provided their insurance number. provincial health care services (unique identifier assigned to each person eligible for provincial health care services). The Center for Health Services and Policy Research (now Population Data BC), which maintains
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