Abstract
Background: Australia's Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative involves a series of Medicare Benefits Schedule (MBS) item numbers which offer a rebate for selected services delivered by eligible clinicians. There has been considerable debate about the appropriateness and effectiveness of Better Access, much of which has been based on limited evidence. The current paper contributes to this debate by presenting the findings of a study which profiled the clinical and treatment characteristics of Better Access patients and examined the outcomes of their care. Method: We approached a stratified random sample of providers who had billed for at least 100 occasions of service under the Better Access item numbers in 2008 (509 clinical psychologists, 640 registered psychologists, 1280 GPs) and invited them to participate. Those who agreed were asked to recruit 5–10 Better Access patients according to a specific protocol. We collected data that enabled us to profile providers, patients and sessions. We also collected pre- and post-treatment patient outcome data, using the Kessler-10 (K-10) and the Depression Anxiety Stress Scales (DASS-21). Results: In total, 883 patients were recruited into the study (289 by 41 clinical psychologists, 317 by 49 registered psychologists and 277 by 39 GPs). More than 90% of participating patients had diagnoses of depression and/or anxiety (compared with 13% of the general population). More than 80% were experiencing high or very high levels of psychological distress (compared with 10% of the general population). Around half of all participating patients had no previous history of mental health care. Patients experienced statistically significant improvements in average K-10 and DASS-21 scores from pre- to post-treatment. Conclusions: The findings suggest that Better Access is playing an important part in meeting the community's previously unmet need for mental health care.
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Acknowledgements
The authors would like to thank the staff of the Australian Government Department of Health and Ageing (DoHA)'s Medical Benefits Division for assisting with sampling and recruitment of providers, Strategic Data for developing and maintaining the minimum data set, and the providers and patients who gave up their time to participate in the study.
Note
1. The hierarchy worked in the following way. Patients with depression and anxiety were classified as having both disorders, irrespective of whether they had additional diagnoses (i.e. alcohol and drug use disorders, psychotic disorders, unexplained somatic disorders, and/or other disorders). Patients with depression but not anxiety were classified as having depression, irrespective of whether they had any of the previously mentioned additional diagnoses. Patients with anxiety but not depression were classified as having anxiety, irrespective of whether they had any of the additional diagnoses. Patients without depression or anxiety were classified as having other disorders, as were those with unknown or missing diagnoses.
Declaration of interest: This work was funded by the DoHA. The authors alone are responsible for the content and writing of the paper.