Trends colliding: aging comprehensive family physicians and the growing complexity of their patients
Premji K, Glazier RH, Green ME, Khan S, Schultz S, Mathews M, Nastos S, Frymire E, Ryan BL. Can Fam Physician. 2025 Jun 16.
Objective — To measure service use and costs associated with healthcare for patients with mental health (MH) and substance use/addiction (SA) problems.
Methods — A 5-year cross-sectional study (2007-2012) of administrative healthcare data was conducted (average annual sample size = 123,235 adults aged >18 years who had a valid Ontario healthcare number and used at least 1 service during the year; 55% female). We assessed average annual use of primary care, emergency departments and hospitals, and overall healthcare costs for patients identified as having MH only, SA only, co-occurring MH and SA problems (MH+SA), and no MH and/or SA (MH/SA) problems. Total visits/admissions and total non-MH/SA visits (i.e., excluding MH/SA visits) were regressed separately on MH, SA, and MH+SA cases compared to non-MH/SA cases using the 2011-2012 sample (N = 123,331), controlling for age and sex.
Results — Compared to non-MH/SA patients, MH/SA patients were significantly (P < 0.001) more likely to visit primary care physicians (1.82 times as many visits for MH-only patients, 4.24 for SA, and 5.59 for MH+SA), use emergency departments (odds, 1.53 [MH], 3.79 [SA], 5.94 [MH+SA]), and be hospitalized (odds, 1.59 [MH], 4.10 [SA], 7.82 [MH+SA]). MH/SA patients were also significantly more likely than non-MH/SA patients to have non-MH/SA-related visits and accounted for 20% of the sample but over 30% of healthcare costs.
Conclusions — MH and SA are core issues for all healthcare settings. MH/SA patients use more services overall and for non-MH/SA issues, with especially high use and costs for MH+SA patients.
Graham K, Cheng J, Bernards S, Wells S, Rehm J, Kurdyak P. Can J Psychiatry. 2017; 62(1):48-56. Epub 2016 Aug 20.
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