Closed for Business? Using a Mixture Model to Explore the Supply of Psychiatric Care for New Patients
Bibliographic record
Abstract
AbstractObjective:To investigate the degree to which psychiatrists are accessible to new outpatients and the factors that predict whether psychiatrists will see new outpatients.Methods:We used administrative health data on all practicing full-time psychiatrists in Ontario, Canada, over a 5-year period (2009-2010 to 2013-2014). We used a regression model to estimate the number of new outpatients seen, accounting for case mix, outpatient volume, and psychiatrist practice characteristics.Results:Approximately 10% of full-time psychiatrists are seeing 1 or fewer new outpatients per month, and another 10% are seeing between 1 and 2 new outpatients per month. Our model identified psychiatrists in 3 distinct practice styles. One practice style (representing 29% of psychiatrists), on average, saw fewer than 2 new outpatients per month and 69 unique outpatients annually. Relative to other practice styles, they tended to see fewer patients with a previous psychiatric hospitalization and fewer patients who lived in lower income neighbourhoods.Conclusions:Nearly 1 in 3 full-time psychiatrists in Ontario see very few new outpatients. This has implications for access to care, particularly for outpatients with newly diagnosed mental illness. It also highlights the continued need to address access issues by assessing the role of psychiatrists within the Canadian health care system. RésuméObjectif:Rechercher le degré auquel les psychiatres sont accessibles à de nouveaux patients, et les facteurs qui prédisent si les psychiatres verront de nouveaux patients ambulatoires.Méthodes:Nous avons utilisé les données administratives sur la santé de tous les psychiatres actifs à temps plein en Ontario, au Canada, sur une période de cinq ans (2009-2010 à 2013-2014). Un modèle de régression a servi à estimer le nombre de nouveaux patients ambulatoires vus, en tenant compte des cas traités, du volume des clients ambulatoires, et des caractéristiques de la pratique des psychiatres.Résultats:Environ 10% des psychiatres à temps plein voient un nouveau patient ambulatoire ou moins par mois, et un autre 10% en voient entre un et deux par mois. Notre densité mélange a identifié des psychiatres dans trois styles de pratique distincts. Un style de pratique (représentant 29% des psychiatres) voyait en moyenne moins que deux nouveaux patients ambulatoires par mois, 69 patients ambulatoires uniques par année, et relativement aux autres styles de pratique, il tendait à voir moins de patients précédemment hospitalisés en psychiatrie, et moins de patients habitant des quartiers à faible revenu.Conclusions:Près d’un psychiatre sur trois psychiatres à temps plein en Ontario voit très peu de nouveaux patients ambulatoires, ce qui a des implications pour l’accès aux soins, particulièrement pour les patients ambulatoires qui ont récemment reçu un diagnostic de maladie mentale. Cela confirme aussi le besoin continu de traiter les questions d’accès en s’interrogeant sur le rôle du psychiatre au sein du système de santé canadien.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.012 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".