Too little time? The recognition and treatment of mental health problems in primary care

Objectives. To assess the effect of practice characteristics on the diagnosis and treatment of mental health problems in primary care. Data Source. National Ambulatory Medical Care Survey (NAMCS) 1991-1994. Study Design. We examine the effect of visit characteristics and practice characteristics on rates of diagnosis of mental health problems, rates of referral, and rates of use of psychotropic medications. We characterize each primary care physician's practice using information about the ways in which that physician treated patients who did not have mental health problems. Principal Findings. We find that median visit duration has a small, statistically insignificant effect on the rate of diagnosis and treatment of mental health problems. Physicians with large HMO caseloads are slightly more likely to diagnose mental health problems, 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 treatment. Conclusions. Physician specialty and practice style are more strongly related to mental health diagnosis and treatment than are system characteristics such as visit duration and insurance composition.