The medical office visit is the foundation of medical care and one of the most important professional activities of primary care physicians who are often the only source of mental health services for older adults. Evidence continues to show that the gap between science and clinical practice remains wide: as many as one half of older adults with a recognized mental disorder fail to receive any mental health services, and even fewer receive evidence-based treatments. Racial minority patients fare even worse. It is an urgent public health concern that such a high proportion of patients needing mental health services are without access to evidence-based care and that racial disparities in access to quality mental health care persist despite advancements in efficacious treatments for mental illnesses. Direct observation of how patients and physicians interact has led to research findings that are straightforward and easily understood by the public and policymakers. It offers a new perspective to study physicians'work and patients'contributions with potentially important new insights. We propose to leverage the infrastructure and data afforded by an ongoing NIH- funded study which is audio-recording 800 annual physical exam visits (checkups designed for physicians to comprehensively review their patients'health) among socioeconomically diverse older adults in a large integrated delivery system, the Henry Ford Health System, in Detroit Michigan and its surrounding suburbs. The proposed study is within the scope of the economics of mental health. We plan to apply mixed methods approach and combine perspectives from mental health services research with behavioral economics, communication research, and statistics. We will use data from audio-recordings, administrative benefits, medication dispensing, claims and encounter records, and surveys of patients and physicians to address the Specific Aims of our study:
Aim 1 : Examine the productivity of physician-patient communication by linking elements of quality of communication on mental health in the context of busy clinics and competing demands from co-morbidities in routine annual checkups with intermediate outcomes such as patient's satisfaction and treatment adherence and distal clinical and economic outcomes including service use and costs.
Aim 2 : Testing for racial disparities in communication content and time using the definition proposed by the Institute of Medicine in Unequal Treatment. We will first qualitatively compare the content and time devoted to mental health and physical health communications between racially concordant and discordant patient-physician pairs. We will assess the contribution of factors that are germane to the practice environment and malleable to policy, e.g., length of visit, co-location of mental and physical health providers to observed disparities. At the completion of the study, we seek to formulate concrete recommendations about specific organizational or clinical interventions that can address these national priorities: translating evidence to practice and eliminating disparities.
The medical office visit is the foundation of medical care and one of the most important professional activities of primary care physicians who are often the only source of mental health services for older adults. Evidence continues to show that the gap between science and clinical practice remains wide: as many as one half of older adults with a recognized mental disorder fail to receive any mental health services, and even fewer receive evidence-based treatments. Racial minority patients fare even worse. It is an urgent public health concern that such a high proportion of patients needing mental health services are without access to evidence- based care and that racial disparities in access to quality mental health care persist despite advancements in efficacious treatments for mental illnesses.
