Healthcare utilization patterns of individuals with depression after national policy to increase the mental health workforce in primary care: a data linkage study

• Published in: BMC family practice Vol. 25; no. 1; pp. 158 - 10
• Main Authors: Dros, Jesper T, van Dijk, Christel E, Böcker, Koen B E, Bruins Slot, Lotte C J A F, Verheij, Robert A, Meijboom, Bert R, Dik, Jan-Willem, Bos, Isabelle
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08-05-2024; BioMed Central; BMC
• Subjects: Adult; Aged; Analysis; Care and treatment; Depression - epidemiology; Depression - therapy; Depression, Mental; Diagnosis related groups; DRGs; Electronic Health Records; Electronic Health Records - statistics & numerical data; Female; General Practice - statistics & numerical data; Health care industry; Health care policy; Health insurance; Health Policy; Health services utilization; Humans; Hypotheses; Laws, regulations and rules; Male; Medical care; Medical Claims Data; Medical policy; Mental depression; Mental disorders; Mental health; Mental Health Nurse; Mental Health Services - statistics & numerical data; Mental Healthcare; Middle Aged; Netherlands - epidemiology; Nurses; Officials and employees; Patient Acceptance of Health Care - statistics & numerical data; Primary care; Primary health care; Primary Health Care - statistics & numerical data; Psychiatric Nursing; Psychiatric personnel; Routine Healthcare Data; Substitution of Care; Utilization; Workforce; Young Adult; Netherlands; Health System reforms; Medical Claims Data; Mental Health Nurse; Mental Healthcare; Substitution of Care; Health Policy; Electronic Health Records; Routine Healthcare Data
• ISSN: 2731-4553; 2731-4553; 1471-2296
• DOI: 10.1186/s12875-024-02402-8

The deployment of the mental health nurse, an additional healthcare provider for individuals in need of mental healthcare in Dutch general practices, was expected to substitute treatments from general practitioners and providers in basic and specialized mental healthcare (psychologists, psychotherapists, psychiatrists, etc.). The goal of this study was to investigate the extent to which the degree of mental health nurse deployment in general practices is associated with healthcare utilization patterns of individuals with depression.
We combined national health insurers' claims data with electronic health records from general practices. Healthcare utilization patterns of individuals with depression between 2014 and 2019 (N = 31,873) were analysed. The changes in the proportion of individuals treated after depression onset were assessed in association with the degree of mental health nurse deployment in general practices.
The proportion of individuals with depression treated by the GP, in basic and specialized mental healthcare was lower in individuals in practices with high mental health nurse deployment. While the association between mental health nurse deployment and consultation in basic mental healthcare was smaller for individuals who depleted their deductibles, the association was still significant. Treatment volume of general practitioners was also lower in practices with higher levels of mental health nurse deployment.
Individuals receiving care at a general practice with a higher degree of mental health nurse deployment have lower odds of being treated by mental healthcare providers in other healthcare settings. More research is needed to evaluate to what extent substitution of care from specialized mental healthcare towards general practices might be associated with waiting times for specialized mental healthcare.