Mental health treatment in primary care: physician treatment choices and psychiatric admission rates.

Objective: To evaluate how primary care physician characteristics, patient characteristics, and adequacy of local specialty resources influenced 1) primary care physician mental health treatment practices, and 2) inpatient psychiatric admission rates.

Methods: A mailed survey was conducted of a stratified sample of 107 primary care physicians in six rural and urban locations. Small area variation data were examined for the six areas to relate survey findings to psychiatric admission rates. We compared characteristics and specialty resources to treatment practices and admission rates through linear and logistic regression analyses.

Results: Survey responses were received from 52% of physicians (n = 56). Respondents and nonrespondents had similar demographic characteristics. Physician characteristics, particularly self-rated confidence, were related to referral, prescription, and on-site counseling practices. Primary care treatment practices were associated with admission rates, especially for substance abuse and dependence.

Conclusions: Attention to studies of physician confidence is indicated, as is attention to studies of providing mental health training and treatment guidelines to primary care physicians, especially for substance abuse.