Primary Mental Health and Substance Use Service Provision by Family Physicians in British Columbia: Exploring Age, Period, and Cohort Trends from 1996-2017

The Canadian province of British Columbia (BC) is currently facing a double crisis: an increasing need for mental health and substance use (MHSU) services, and a perceived shortage in the supply of primary care services which in part has been related to the ageing of the family physician (FP) labour force in the province. For this thesis, we use administrative data containing billing and demographic information for FPs in BC between 1996 and 2017 to conduct three studies. In the first study, we use graphical analysis, analysis of variance (ANOVA), and Chi-Square tests to assess differences in service provision stratified by FP age, graduating cohort, and time period. In the second study, we apply three age-period-cohort (APC) models to compare the relative impact of these three variables in determining changes in MHSU service provision by FPs. In the third study, we use latent class analysis (LCA) to explore the extent to which there are identifiable classes of FPs comprising the FP population in 1996 and. This study also aims to describe whether and how different classes of FPs have changed in BC over this period, and to provide insight into how recent practice environments may shape access to primary care MHSU services. This thesis demonstrates that changing demographics of the FP labour force in BC can be expected to lead to changes in access to primary care. We found limited evidence that changes can be attributed to different practice styles in newer generations of FPs. Finally, there are new typologies of FP practice style emerging over the last 20 years which suggests that there has been a fundamental shift in the ways that FPs are providing MHSU services and how many they are providing. These findings point to a need to increase the available stock of MHSU services, including improving care collaboration and availability among alternate providers for MHSU patients to take some of the burden off FPs, increase the supply of FPs to replace those that are beginning to retire, and consider whether current remuneration methods incentivize adequate provision of MHSU services by FPs.

Department dc:contributor.department

Health Policy, Management and Evaluation

Year dc:date.issued

2024

Author dc:creator

• Jamieson, Margaret

Advisors dc:contributor.advisor

• Rudoler, David
• Laporte, Audrey

• Age period cohort modeling
• Health economics
• Mental health
• Primary care

Handle dc:identifier.uri

http://hdl.handle.net/1807/139923

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/139923