TOO LITTLE TIME - THE RECOGNITION AND TREATMENT OF MENTAL-HEALTH PROBLEMS IN PRIMARY-CARE

Objectives. To assess the effect of practice characteristics on the di agnosis and treatment of mental health problems in primary care. Data Source. National Ambulatory Medical Care Survey (NAMCS) 1991-1994. Stu dy Design. We examine the effect of visit characteristics and practice characteristics on rates of diagnosis of mental health problems, rate s of referral, and rates of use of psychotropic medications. We charac terize each primary care physician's practice using information about the ways in which that physician treated patients who did not have men tal health problems. Principal Findings. We find that median visit dur ation has a small, statistically insignificant effect on the rate of d iagnosis and treatment of mental health problems. Physicians with larg e HMO caseloads are slightly more likely to diagnose mental health pro blems, but less likely to prescribe psychotropic medications, than are physicians who see few HMO patients. Practice style and specialty are important determinants of diagnosis and, to a lesser extent, of treat ment. Conclusions. Physician specialty and practice style are more str ongly related to mental health diagnosis and treatment than are system characteristics such as visit duration and insurance composition.