Using multi-regional data to understand access to psychiatric care in Canada
Mental illness is the leading cause of disability in Canada and worldwide. On the heels of a global pandemic, one in five Canadians reported needing help with their mental health, but almost half said they didn’t receive the care they needed. While some place the blame on a psychiatrist shortage, a steady number of practitioners suggests there may be other reasons – and Dr. David Rudoler wants to know what they are.
“It’s easy to say the supply of psychiatric care is insufficient,” said Dr. Rudoler, Associate Professor at Ontario Tech University and Research Chair at Ontario Shores. “But that’s only been explored provincially.” That’s why Dr. Rudoler and his colleagues are investigating psychiatrist practice patterns and the supply of psychiatric care cross-provincially, using HDRN Canada’s Data Access Support Hub (DASH).
Having a single entry point to the data access process will hopefully enable more cross-provincial or pan-Canadian research, which allows us to identify important differences in how health care is being delivered and assess the effects of provincial policy interventions.
The Pan-Canadian Study of Psychiatric Care (PCPC) is the first multi-province study of the psychiatrist workforce in Canada. It uses administrative data from British Columbia, Manitoba and Ontario to examine psychiatrist practice patterns and the supply of psychiatric care cross-provincially. Funded by the Canadian Institutes of Health Research, the study examines practice patterns like the types of services being provided, who has access to those services, where the services are located in each province, and the demographics of the psychiatrist workforce.
The project was inspired by Dr. Rudoler’s previous research, which examined the characteristics of the psychiatrist workforce in Ontario. He originally became interested in the subject during his postdoctoral work at the Centre for Addiction and Mental Health. This new research seeks to expand the scope of his previous work to discover any consistencies or differences in how psychiatrists practice across the country. The research team used HDRN Canada’s DASH to access multi-regional administrative data, which are data that are routinely collected as part of health care delivery. Now that Dr. Rudoler’s team has received the data from all three provinces, they are looking forward to proceeding with their analysis.
According to Dr. Rudoler, using multi-regional data for this study is critical. “It enables our research team to determine if patterns identified in one province are consistent in others. For example, in Ontario we found key differences in how psychiatrists practice in rural areas versus urban areas.” The researchers want to see if these patterns related to population density were the same in other provinces as a way of understanding how geography impacts the supply of psychiatrists.
Using data from multiple provinces also allows researchers to examine the impact of different provincial policies and interventions, such as policies that dictate how psychiatrists are compensated and the methods provinces use to recruit and retain psychiatrists in certain communities. “All of these could influence how and where psychiatrists choose to practice and the distribution of services in each province, which in turn has implications for mental health care across the country,” Dr. Rudoler continued. HDRN Canada’s DASH ensured that Dr. Rudoler and his team could access the data they needed through a single contact and point of entry. “DASH really helps to shelter the researcher from the various administrative processes of each data centre. Instead of having to go through three or four data access requests, there is one.”
DASH is a one-stop shop for researchers who require administrative data from more than one territorial, provincial or pan-Canadian data organization. It also provides information on the availability of data assets, common algorithms, privacy legislation and data access processes across Canada. Since its launch in 2020, DASH has served as a single intake point for researchers, coordinating initial project reviews, confirming the eligibility and feasibility of data requests, offering cost estimates, and providing centralized data access support from conceptualization through to data delivery. “While there are still things like Research Ethics Board approvals to be done in each province, there is a greater degree of harmonization in terms of how data requests are formulated and how documentation is put together,” Dr. Rudoler added.
There was also greater clarity and transparency working with DASH to access multi-regional data, he explained. “By creating a detailed plan outlining the specific types of data needed across three different provinces, the DASH team highlighted important differences as well as the extent to which data elements could be harmonized.” The DASH team also facilitates communication among the individual data centres and the analysts who review and prepare the data. “In the long run, because we have taken that time upfront to make sure we’ve done it right, it’s going to give us much more confidence in the final product than if we had done this one-off process in each province.”
Dr. Rudoler underscored the importance of multi-regional data for Canadian health researchers. “But because of the way our health care system is organized, with health care delivered provincially, the data are located in separate data centres in each province, which can incentivize researchers to limit their research to one province,” he said. “Having a single entry point to the data access process will hopefully enable more cross-provincial or pan-Canadian research, which allows us to identify important differences in how health care is being delivered and assess the effects of provincial policy interventions.”