--- title: "Health exams: missed opports. in mental health care. | Sutter Health" description: "Visits with MDs who spent more time with pts, fully elicit pts’ agendas, and let pts talk were more likely to give evid-based mental health discussions." url: "https://www.sutterhealth.org/research/publications/health-exams-missed-opports-mental-health-care-1055312291" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Health exams: missed opports. in mental health care. # Periodic health examinations and missed opportunities among patients likely needing mental health care. Tai-Seale M, Hatfield LA, Wilson CJ, Stults CD, McGuire TG, Diamond LC, Frankel RM, MacLean L, Stone A, & Lafata JE. _Am J Manag Care. 22(10):E350-7._ 2016-10-01 ## Abstract Objectives: Periodic health examinations (PHEs) are the most common reason adults see primary care providers. It is unknown if PHEs serve as a “safe portal” for patients with mental health needs to initiate care. We examined how physician communication styles impact mental health service delivery in PHEs. Study Design: Retrospective observational study using audio-recordings of 255 PHEs with patients likely to need mental health care. Methods: Mixed-methods examined the timing of a mental health discussion (MHD), its quality, and the relationship between MHD quality and physician practice styles. MHD quality was measured against evidence-based practices as a 3-level variable (evidence-based, perfunctory, or absent). Physician practice styles were measured by: visit length, verbal dominance, and elicitation of a patient’s agenda. A generalized ordered logit model was used. Results: Many patients came with mental health concerns, as over 50% of the MHDs occurred in the first 5 minutes of the visit. One-third of the 255 patients had an evidence-based MHD, another third had a perfunctory MHD, and the remaining had no MHD. MHD quality was significantly associated with physician communication styles. Visits with physicians who tend to spend more time with patients, fully elicit patients’ agendas, and let patients talk (instead of being verbally dominant) were more likely to deliver evidence-based MHD. Conclusions: If done well, PHEs could be a safe portal for patients to seek mental health care, but most PHEs fell short. Improving PHE quality may require reimbursement for longer visits and coaching for physicians to more fully elicit patients’ agendas and to listen more attentively. [PubMed abstract](http://tinyurl.com/kolh4n2) ![Cheryl Stults, Ph.D.](https://dyn.mktgcdn.com/p/3IhveEwq-t5WoqAzSNGeAr-4g4yrj4v7x1QcPGdCX_s/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Cheryl Stults, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/cheryl-stults-phd-1049681000) ## Research topics - [Health Policy](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Policy%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Mental Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Mental+Health%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Association of mandated language access programming and quality of care provided by mental health agencies.](https://www.sutterhealth.org/research/publications/lang-access-care-quality-mental-health-agencies-1055312895) McClellan SR, Snowden L. Psychiatr Serv. 2014 Sep 15. doi: 10.1176/appi.ps.201300522. \[Epub ahead of print\] 2014 Sep 15 - Publication ### [The impact of threshold language assistance programming on the accessibility of mental health services for persons with limited English proficiency in the Medi-Cal setting.](https://www.sutterhealth.org/research/publications/language-help-and-access-to-mental-health-services-1055312803) McClellan SR, Wu FM, Snowden LR. Med Care. 50(6):554-8. doi: 10.1097/MLR.0b013e3182463432. 2012 Jun 01 - Publication ### [Shared decision making as part of value based care: new U.S. policies challenge our readiness.](https://www.sutterhealth.org/research/publications/shared-decision-making-new-united-states-policies-1055312408) Spatz ES, Elwyn G, Moulton BW, Volk RJ, Frosch DL. Z Evid Fortbild Qual Gesundhwes. pii: S1865-9217(17)30087-9. doi: 10.1016/j.zefq.2017.05.012. \[Epub ahead of print\] 2017 May 20 - Publication ### [Psychotropic medication discussions in older adults' primary care office visits: So much to do, so little time.](https://www.sutterhealth.org/research/publications/psychotropic-med-discussions-in-older-adults-in-pc-1055312596) Ahn S, Tai-Seale M, Huber C Jr, Smith ML, Ory MG. Aging Ment Health. 15(5):618-29. doi: 10.1080/13607863.2010.548055. 2011 Jul 01 - Publication ### [Health care for the working poor: from focus groups to state policy.](https://www.sutterhealth.org/research/publications/healthcare-wking-poor-focus-grps-state-policy-1055312329) Tierney WM, Kinney ED, Tai-Seale M, Greene JY, Murray R, Latondress T. J Investig Med. 46(7):279A. 1998 Jul 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/health-exams-missed-opports-mental-health-care-1055312291#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Health exams: missed opports. in mental health care."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/health-exams-missed-opports-mental-health-care-1055312291#medicalscholarlyarticle","name":"Periodic health examinations and missed opportunities among patients likely needing mental health care.","headline":"Health exams: missed opports. in mental health care.","abstract":"Objectives: Periodic health examinations (PHEs) are the most common reason adults see primary care providers. It is unknown if PHEs serve as a “safe portal” for patients with mental health needs to initiate care. We examined how physician communication styles impact mental health service delivery in PHEs. Study Design: Retrospective observational study using audio-recordings of 255 PHEs with patients likely to need mental health care. Methods: Mixed-methods examined the timing of a mental health discussion (MHD), its quality, and the relationship between MHD quality and physician practice styles. MHD quality was measured against evidence-based practices as a 3-level variable (evidence-based, perfunctory, or absent). Physician practice styles were measured by: visit length, verbal dominance, and elicitation of a patient’s agenda. A generalized ordered logit model was used. Results: Many patients came with mental health concerns, as over 50% of the MHDs occurred in the first 5 minutes of the visit. One-third of the 255 patients had an evidence-based MHD, another third had a perfunctory MHD, and the remaining had no MHD. MHD quality was significantly associated with physician communication styles. Visits with physicians who tend to spend more time with patients, fully elicit patients’ agendas, and let patients talk (instead of being verbally dominant) were more likely to deliver evidence-based MHD. Conclusions: If done well, PHEs could be a safe portal for patients to seek mental health care, but most PHEs fell short. Improving PHE quality may require reimbursement for longer visits and coaching for physicians to more fully elicit patients’ agendas and to listen more attentively.","description":"Visits with MDs who spent more time with pts, fully elicit pts’ agendas, and let pts talk were more likely to give evid-based mental health discussions.","keywords":["Health Policy","Health Services","Mental Health"],"datePublished":"2016-10-01","url":"https://www.sutterhealth.org/research/publications/health-exams-missed-opports-mental-health-care-1055312291","inLanguage":"en-US","isPartOf":{"@type":"Periodical","name":"Am J Manag Care"},"author":[{"@type":"Person","name":"Tai-Seale M"},{"@type":"Person","name":"Hatfield LA"},{"@type":"Person","name":"Wilson CJ"},{"@type":"Person","@id":"https://www.sutterhealth.org/research/investigators/cheryl-stults-phd-1049681000","name":"Stults CD","url":"https://www.sutterhealth.org/research/investigators/cheryl-stults-phd-1049681000"},{"@type":"Person","name":"McGuire TG"},{"@type":"Person","name":"Diamond LC"},{"@type":"Person","name":"Frankel RM"},{"@type":"Person","name":"MacLean L"},{"@type":"Person","name":"Stone A"},{"@type":"Person","name":"Lafata JE"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Health Policy","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Policy%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Health Services","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Services%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Mental Health","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Mental+Health%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/health-exams-missed-opports-mental-health-care-1055312291","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/health-exams-missed-opports-mental-health-care-1055312291#breadcrumblist"}}} ```