Allocation of Healthcare Professional Resources in Outpatient Specialised Psychiatric Care: Insights from the First Two Years Post-Depression Diagnosis
P. Näätänen, P. Vänni, G. Joffe, J. Ekelund, J. Juntura, T. Ito, O. Isomeri, I. Eriksson, P. TorkkiIntroduction
Appropriate, timely allocation of healthcare professional (HCP) resources in specialised psychiatric care (SPC) is key for delivering value-based healthcare. Healthcare systems are challenged with balancing outpatient and inpatient care, and optimising consultation, assessment, and treatment planning and administration to maximise patient (pt) outcomes (Wallang et al. Br J Hosp Med 2018; 79 322–327). Reviewing real-world resource utilisation can identify deviations from optimal care processes and improve pt contact with HCPs, leading to better outcomes.
Objectives
To analyse HCP resource allocation over 2 years (yrs) post-depression diagnosis by outpatient SPC, examining contact frequency, service type, and the effects of age and sex.
Methods
This cohort study leveraged Finnish electronic health records from 2014–2020. All pts with a depression diagnosis recorded by SPC at Helsinki University Hospital (HUS) in 2018 (with no depression diagnosis given by SPC within the previous 4 yrs) were included. All HCP resource use data, including outpatient services with structurally coded service parameters (type and provider), were evaluated.
Results
A total of
4,830 pts were included. The proportion of consultations, assessments and care plans, and contact with medical doctors, was highest in the first 2 months post-diagnosis vs the remaining follow-up period, during which contact with nurses was highest (
Fig A–B
). For pts aged 18–64 yrs, HCP contact was more than twice as frequent in the first month post-diagnosis vs subsequent months (
Fig C
). For pts aged 0–17 yrs, overall HCP contact was ~2 times higher and more consistent over the follow-up than for pts aged 18–64 yrs. This increased care was primarily provided by nurses and psychologists; hence, the proportion of contact with medical doctors was lower for pts aged 0–17 vs 18–64 yrs. Pts aged 0–22 yrs received proportionally more psychotherapeutic interventions vs other age groups. The frequency and diversity of HCP contact was lowest for pts aged >65 yrs. There were no differences in care between sexes in the first month post-diagnosis; however, female pts received more frequent care than male pts during the remaining follow-up period (
Fig D
).
Image 1: Long description.