Integrating youth mental health practice nurses into general practice: effects on outpatient mental health care utilization among children and adolescents
Integration of child mental health services in general practice may improve early detection and treatment and reduce strain on specialized services. In this study we investigated whether outpatient mental health care utilization and associated costs in children and adolescents were affected by the i...
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| Published in: | European child & adolescent psychiatry Vol. 34; no. 7; pp. 2145 - 2154 |
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| Format: | Journal Article |
| Language: | English |
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Springer Berlin Heidelberg
01.07.2025
Springer Nature B.V |
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| ISSN: | 1018-8827, 1435-165X, 1435-165X |
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| Abstract | Integration of child mental health services in general practice may improve early detection and treatment and reduce strain on specialized services. In this study we investigated whether outpatient mental health care utilization and associated costs in children and adolescents were affected by the introduction of youth mental health practice nurses (YMHPNs) in general practice. We linked healthcare data of the Rijnmond Primary Care Database to municipal registry data on child outpatient mental health care expenditures between 2019 and 2022. Using mixed models, we assessed if the presence of a YMHPN in practices was associated with outpatient mental health care utilization. Our cohort consisted of 33,971 children aged 0–17 years registered in 38 general practices in Rotterdam, the Netherlands. 5.5% of these children attended outpatient mental health services between 2019 and 2022. The proportion of children utilizing outpatient mental health care and associated costs increased over time. After correction for practice demographics and trends over time, the presence of a YMHPN in a practice was associated with small non-significant reductions in the number of children receiving outpatient care (Rate Ratio = 0.99, 95%CI 0.92 to 1.06) and associated costs (-395.80 euros 95%CI -1431.27 to 639.67) compared with practices without YMHPN. Considering the study limitations, we cautiously concluded that the introduction of YMHPNs in general practice was not associated with significant changes in outpatient mental health care utilization one to four years after implementation. Future studies should elucidate the long-term impact and underlying changes in pathways to care due to the introduction of the YMHPN. |
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| AbstractList | Integration of child mental health services in general practice may improve early detection and treatment and reduce strain on specialized services. In this study we investigated whether outpatient mental health care utilization and associated costs in children and adolescents were affected by the introduction of youth mental health practice nurses (YMHPNs) in general practice. We linked healthcare data of the Rijnmond Primary Care Database to municipal registry data on child outpatient mental health care expenditures between 2019 and 2022. Using mixed models, we assessed if the presence of a YMHPN in practices was associated with outpatient mental health care utilization. Our cohort consisted of 33,971 children aged 0–17 years registered in 38 general practices in Rotterdam, the Netherlands. 5.5% of these children attended outpatient mental health services between 2019 and 2022. The proportion of children utilizing outpatient mental health care and associated costs increased over time. After correction for practice demographics and trends over time, the presence of a YMHPN in a practice was associated with small non-significant reductions in the number of children receiving outpatient care (Rate Ratio = 0.99, 95%CI 0.92 to 1.06) and associated costs (-395.80 euros 95%CI -1431.27 to 639.67) compared with practices without YMHPN. Considering the study limitations, we cautiously concluded that the introduction of YMHPNs in general practice was not associated with significant changes in outpatient mental health care utilization one to four years after implementation. Future studies should elucidate the long-term impact and underlying changes in pathways to care due to the introduction of the YMHPN. Integration of child mental health services in general practice may improve early detection and treatment and reduce strain on specialized services. In this study we investigated whether outpatient mental health care utilization and associated costs in children and adolescents were affected by the introduction of youth mental health practice nurses (YMHPNs) in general practice. We linked healthcare data of the Rijnmond Primary Care Database to municipal registry data on child outpatient mental health care expenditures between 2019 and 2022. Using mixed models, we assessed if the presence of a YMHPN in practices was associated with outpatient mental health care utilization. Our cohort consisted of 33,971 children aged 0-17 years registered in 38 general practices in Rotterdam, the Netherlands. 5.5% of these children attended outpatient mental health services between 2019 and 2022. The proportion of children utilizing outpatient mental health care and associated costs increased over time. After correction for practice demographics and trends over time, the presence of a YMHPN in a practice was associated with small non-significant reductions in the number of children receiving outpatient care (Rate Ratio = 0.99, 95%CI 0.92 to 1.06) and associated costs (-395.80 euros 95%CI -1431.27 to 639.67) compared with practices without YMHPN. Considering the study limitations, we cautiously concluded that the introduction of YMHPNs in general practice was not associated with significant changes in outpatient mental health care utilization one to four years after implementation. Future studies should elucidate the long-term impact and underlying changes in pathways to care due to the introduction of the YMHPN.Integration of child mental health services in general practice may improve early detection and treatment and reduce strain on specialized services. In this study we investigated whether outpatient mental health care utilization and associated costs in children and adolescents were affected by the introduction of youth mental health practice nurses (YMHPNs) in general practice. We linked healthcare data of the Rijnmond Primary Care Database to municipal registry data on child outpatient mental health care expenditures between 2019 and 2022. Using mixed models, we assessed if the presence of a YMHPN in practices was associated with outpatient mental health care utilization. Our cohort consisted of 33,971 children aged 0-17 years registered in 38 general practices in Rotterdam, the Netherlands. 5.5% of these children attended outpatient mental health services between 2019 and 2022. The proportion of children utilizing outpatient mental health care and associated costs increased over time. After correction for practice demographics and trends over time, the presence of a YMHPN in a practice was associated with small non-significant reductions in the number of children receiving outpatient care (Rate Ratio = 0.99, 95%CI 0.92 to 1.06) and associated costs (-395.80 euros 95%CI -1431.27 to 639.67) compared with practices without YMHPN. Considering the study limitations, we cautiously concluded that the introduction of YMHPNs in general practice was not associated with significant changes in outpatient mental health care utilization one to four years after implementation. Future studies should elucidate the long-term impact and underlying changes in pathways to care due to the introduction of the YMHPN. |
| Author | Verhoog, Sanne Gerger, Heike de Schepper, Evelien I. T. Koet, Lukas B. M. Bindels, Patrick J. E. Erdem, Özcan Jansen, Wilma |
| Author_xml | – sequence: 1 givenname: Lukas B. M. surname: Koet fullname: Koet, Lukas B. M. email: l.koet@erasmusmc.nl organization: Department of General Practice, Erasmus MC, University Medical Centre Rotterdam – sequence: 2 givenname: Sanne surname: Verhoog fullname: Verhoog, Sanne organization: Department of Public Health, Erasmus MC, University Medical Centre Rotterdam – sequence: 3 givenname: Özcan surname: Erdem fullname: Erdem, Özcan organization: Department of Research and Business Intelligence, Municipality of Rotterdam – sequence: 4 givenname: Heike surname: Gerger fullname: Gerger, Heike organization: Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, Department of Clinical Psychology, Open University – sequence: 5 givenname: Patrick J. E. surname: Bindels fullname: Bindels, Patrick J. E. organization: Department of General Practice, Erasmus MC, University Medical Centre Rotterdam – sequence: 6 givenname: Evelien I. T. surname: de Schepper fullname: de Schepper, Evelien I. T. organization: Department of General Practice, Erasmus MC, University Medical Centre Rotterdam – sequence: 7 givenname: Wilma surname: Jansen fullname: Jansen, Wilma organization: Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Department of Social Development, City of Rotterdam |
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| Cites_doi | 10.1016/j.pcl.2015.08.005 10.1001/jamapediatrics.2015.1141 10.1007/s00787-022-01961-4 10.1037/cpp0000231 10.1093/pubmed/fdae008 10.1056/NEJMsa1413512 10.1007/s00787-018-1218-9 10.1007/s00787-022-02077-5 10.1136/bmjopen-2020-042052 10.3399/BJGP.2021.0557 10.1001/jamapsychiatry.2020.0279 10.1186/s12875-015-0354-2 10.1111/jcpp.12372 10.1371/journal.pmed.1001885 10.1016/j.socscimed.2020.113542 10.1038/s41380-023-02202-z 10.1093/ije/dyac026 10.1186/s12875-022-01802-y 10.32614/RJ-2017-066 10.1136/ebmental-2021-300277 10.1186/s12875-022-01873-x 10.1037/fsh0000251 10.1001/jamapsychiatry.2013.3074 10.1007/s00787-019-01469-4 10.1007/s12445-020-0578-9 10.1016/S0140-6736(11)60827-1 10.3399/bjgp16X687061 10.1016/j.childyouth.2021.106288 |
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| SubjectTerms | Adolescent Adolescents Ambulatory Care - statistics & numerical data Child Child & adolescent mental health Child and Adolescent Psychiatry Child, Preschool Children Childrens health Costs Demography Drug prices Female General practice General Practice - organization & administration General Practice - statistics & numerical data Health behavior Health care Health care expenditures Health care policy Health services utilization Humans Implementation Infant Infant, Newborn Integrated care Male Medicine Medicine & Public Health Mental health Mental health care Mental health services Mental Health Services - economics Mental Health Services - statistics & numerical data Netherlands Nurses Outpatient services Outpatient treatment Patient Acceptance of Health Care - statistics & numerical data Practice nurses Practice nursing Primary care Psychiatric nurses Psychiatric Nursing Psychiatric-mental health nursing Psychiatry Specialized services Youth |
| Title | Integrating youth mental health practice nurses into general practice: effects on outpatient mental health care utilization among children and adolescents |
| URI | https://link.springer.com/article/10.1007/s00787-024-02619-z https://www.ncbi.nlm.nih.gov/pubmed/39666035 https://www.proquest.com/docview/3237849497 https://www.proquest.com/docview/3146652029 https://pubmed.ncbi.nlm.nih.gov/PMC12334438 |
| Volume | 34 |
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