Grant: Catalyst Gr.: Quadruple Aim and Equity-National Mental Health Service Standards

To improve access to mental health care in primary care settings during the COVID-19 pandemic, the Ontario Ministry of Health (MOH) approved new physician billing codes for virtual assessments by telephone or video. These changes in the delivery of care and the payment received through different primary care models may have affected family physicians' behaviour regarding the quantity of virtual and in-person mental health care provided. This research will mobilize knowledge to inform the MOH policymakers on how mental health services can be effectively integrated and delivered to Ontarians during and after the pandemic through primary care. We will determine which payment model maximizes virtual and in-person mental health care and how important are the temporary virtual visit codes recently introduced for mental health care delivery. This study will provide the initial groundwork for a more extensive examination of patient-level experiences and mental health outcomes observed before and after the pandemic, including clinical data on patient mental health and diverse patient perspectives to understand population experiences accessing and receiving virtual care in future research. The main objectives of this study are to compare physician provision of virtual and in-person mental health care services before and after the COVID-19 pandemic in Ontario's dominant primary care delivery models: blended fee-for-service, blended capitation, and team-based primary care. We will also apply a sex and gender lens in the proposed research to provide new evidence about the impact of gender and age differences in primary care physicians' delivery of mental health care and propose action to address them as highlighted by the MOH. To achieve these objectives, we will use Ontario health administrative data held at the Institute for Clinical Evaluative Sciences and work collaboratively with the MOH to compare patterns overtime before and during the first two years of the pandemic.