Factors influencing short-term effectiveness and efficiency of the care provided by Dutch general practice mental health professionals

Tosca G R Vennemann; Ben F M Wijnen; Lianne Ringoir; Audry Kenter; Marja J H van Bon-Martens; Rob J M Alessie; Jasper Nuyen

doi:10.33393/grhta.2020.2028

Factors influencing short-term effectiveness and efficiency of the care provided by Dutch general practice mental health professionals

Glob Reg Health Technol Assess. 2020 Dec 14:7:139-147. doi: 10.33393/grhta.2020.2028. eCollection 2020 Jan-Dec.

Authors

Tosca G R Vennemann¹, Ben F M Wijnen^{2

3}, Lianne Ringoir⁴, Audry Kenter^{5

6}, Marja J H van Bon-Martens², Rob J M Alessie¹, Jasper Nuyen⁷

Affiliations

¹ Department of Economics, Econometrics & Finance, Faculty of Economics and Business, University of Groningen, Groningen - The Netherlands.
² Center for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht - The Netherlands.
³ Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht - The Netherlands.
⁴ Care Group PoZoB, Veldhoven - The Netherlands.
⁵ General Practice Stroes & Lems, Driebergen - The Netherlands.
⁶ Chair, Scientific Research Committee, National Association of General Practice Mental Health Care Professionals (LV POH GGZ), Harderwijk - The Netherlands.
⁷ Department of Reintegration and Community Care, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht - The Netherlands.

Abstract

Introduction: This study examined whether factors related to general practice mental health professionals (GP-MHPs), that is, characteristics of the professional, the function, and the care provided, were associated with short-term effectiveness and efficiency of the care provided by GP-MHPs to adults in Dutch general practice.

Methods: A prospective cohort study was conducted among 320 adults with anxiety or depressive symptoms who had an intake consultation with GP-MHPs (n = 64). Effectiveness was measured in terms of change in quality-adjusted life years (QALYs) 3 months after intake; and efficiency in terms of net monetary benefit (NMB) at 3-month follow-up. A range of GP-MHP-related predictors and patient-related confounders was considered.

Results: Patients gained on average 0.022 QALYs at 3-month follow-up. The mean total costs per patient during the 3-month follow-up period (€3,864; 95% confidence interval [CI]: €3,196-€4,731) decreased compared to that during the 3 months before intake (€5,220; 95% CI: €4,639-€5,925), resulting largely from an increase in productivity. Providing mindfulness and/or relaxation exercises was associated with QALY decrement. Having longer work experience as a GP-MHP (≥2 years) and having 10-20 years of work experience as a mental health care professional were negatively associated with NMB. Furthermore, a higher number of homework exercises tended to be related to less efficient care. Finally, being self-employed and being seconded from an organization in which primary care and mental health care organizations collaborate were related to a positive NMB, while being seconded from a mental health organization tended towards such a relationship.

Conclusions: Findings seem to imply that the care provided by GP-MHPs contributes to improving patients' functioning. Some GP-MHP-related characteristics appear to influence short-term effectiveness and efficiency of the care provided. Further research is needed to confirm and better explain these findings and to examine longer-term effects.

Keywords: Costs; General practice mental health professionals; Mental disorders; Net benefit; Netherlands; Quality-adjusted life year.