Financial and Non-Financial Incentives That Influence Quality Care for Depression and Anxiety in Ontario Interprofessional Health Teams: Findings from a Grounded Theory Study

Background: Social work can respond to a broad range of clinical needs that emerge in primary health care (PHC). Despite expansion of social work into PHC, few studies have examined the integration of social work and allied health professionals in new team-based models of care that have emerged across Canada. Family Health Teams are intended to address problems of access and quality and respond to the need for better chronic disease prevention and management. Yet, there has been marginal uptake and improvement in mental health care by newer interprofessional primary care teams. A stronger understanding of the full range of non-financial and financial incentives and disincentives and their interrelationships will help stakeholders address significant gaps in the prevention and management of common mental disorders (CMDs) that adversely affect those most vulnerable and marginalized in our communities

Purpose: To develop a model that explains financial and non-financial incentives that can be leveraged by stakeholders to improve access to high-quality care for common mental disorders in interprofessional primary health care teams.

Methods: This three-year qualitative study uses grounded theory methodology. Semi-structured interviews have been conducted with a purposive sample of diverse healthcare professionals and managers within FHTs, community mental health providers, and policy and decisions-makers. 100 interviews have been completed with participants who represent 17 FHTs and span 9 Local Health Integration Networks (LHINs).

Results: The poster will present our emerging theoretical model which describes the types of incentives influencing teams and clinicians, the mechanisms through which these incentives appear to be working, and the areas of quality affected by them.  Participants have identified a wide range of financial (e.g. funding models, remuneration schemes, bonuses) and non-financial (e.g. training opportunities) incentives affecting mental health care, and a number of mechanisms have been revealed (e.g. autonomy, mastery, connectedness).  These quality care dimensions explored in the study include technical care, access, equity, structural, person-centeredness, and efficiency.

Conclusions: The development of an incentive model will help guide policy makers and stakeholders to improve prevention and management of CMDs in FHTs.

Implications: The incentive model will help stakeholders understand the levers and pathways of change they can use to improve care quality for CMDs in primary care.  This is especially timely for Ontario, where a regional strategy for primary care resources, including the availability and role of mental health workers is underway.