Health system use among patients with mental health conditions in a community based sample in Toronto, Canada: A retrospective cohort study

Kimberly Lazare; Sumeet Kalia; Babak Aliarzadeh; Steven Bernard; Rahim Moineddin; David Eisen; Michelle Greiver; David Kaplan; David Koczerginski; Maria Muraca; Wai Lun Alan Fung; Braden O’Neill

doi:10.1371/journal.pone.0266377

Peer Review History

Original SubmissionMay 3, 2021
11 Nov 2021 Decision Letter - Enkeleint A. Mechili, Editor PONE-D-21-14663Health system use among patients with mental health conditions in a community based sample in Toronto, Canada: A retrospective cohort studyPLOS ONE Dear Dr. Lazare, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by 25 November 2021. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Enkeleint A. Mechili Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf, 2. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This Canadian paper is well written and the authors clearly mention the limitations of this cross-sectional study. I have two remarks; the first one is about the lack of a theoretical framework that has guided the study. In the literature, there are several theoretical models that address utilization care services. One of them is the Andersen health behavior model that has been widely recognized as a reliable tool for the study of health services utilization. According to this model, health service utilization could be considered as function of three sets of factors: predisposing (demographic and social) factors, enabling (economic) factors, and need (health outcomes) factors. The authors could address adequately the theoretical reasoning of their study and explain to what extent it guided the study design. The second one is relevant with the external validity of the study. It is obvious that the study findings cannot be generalized in setting outside the Canadian context. However, there are issues that can be learned and transmitted to the non-Canadian readers and the authors could discuss further this subject in a revised version. Reviewer #2: General comment: The manuscript reported health service use among people identified as having mental health conditions, which is very important for psychiatric patients as access to health care facilities is so crucial issue. Keywords: Much better to have keywords as Mesh term to make your research more popular. Please review and amend accordingly Abstract: Try to avoid first person pronouns when writing academic papers. I would suggest reviewing the method section in the abstract. Introduction: is well-written and clear to me. Methodology: The Methods section provided in depth details. However, authors did not explain why they have selected such duration (2012-2019), was that based on a specific factor? Also, regarding common mental health diagnosis: why dual diagnosis was not part in this? Results: No comments, the results section is thorough and supported by the analysed data. Discussion: The Discussion section is comprehensive. However, I was hoping to see more of other comparative trials from other places in the world when comparing the results to make sense of the reproducibility of the research. Conclusion: well-written ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0266377.r001
Revision 1
12 Feb 2022 Author Response November 18, 2021 Rebuttal Letter: PONE-D-21-14663 Dear Editors, We thank the reviewers for their thoughtful comments regarding our manuscript entitled Health system use among patients with mental health conditions in a community-based sample in Toronto, Canada: A retrospective cohort study. We have edited the manuscript to address their concerns. We believe that the manuscript is now suitable for publication in PLOS One. Reviewer #1: This Canadian paper is well written and the authors clearly mention the limitations of this cross-sectional study. I have two remarks; the first one is about the lack of a theoretical framework that has guided the study. In the literature, there are several theoretical models that address utilization care services. One of them is the Andersen health behavior model that has been widely recognized as a reliable tool for the study of health services utilization. According to this model, health service utilization could be considered as function of three sets of factors: predisposing (demographic and social) factors, enabling (economic) factors, and need (health outcomes) factors. The authors could address adequately the theoretical reasoning of their study and explain to what extent it guided the study design. Thank you for the suggestion to enhance our description of the theoretical reasoning of our study. We have included details about the ‘Andersen’ model and how it relates to what data we had access to as follows: In ‘introduction’ (p.2): “Healthcare utilization is determined by multiple factors related to patient and health system characteristics. One common explanatory framework for this is the Andersen’s behavioural model of health service use [14]. This describes ‘predisposing’ factors such as demographics and health beliefs, ‘enabling’ factors such as financing and organization, and ‘need’ factors related to symptoms and functional impairment from disease.” In ‘interpretation’ (p.13): “In this study we were limited in addressing all components of Andersen’s model by the data to which we had access: the underlying database did not include some data elements that would be necessary to characterize healthcare utilization according to all of Andersen’s concepts, such as race and ethnicity and symptom severity. However, we were able to assess aspects of all of those key factors.” The second one is relevant with the external validity of the study. It is obvious that the study findings cannot be generalized in setting outside the Canadian context. However, there are issues that can be learned and transmitted to the non-Canadian readers and the authors could discuss further this subject in a revised version. Thank you for this important point, which we have further addressed in the manuscript as follows (interpretation, p.14): “Since the study population in this article was limited to localized primary care offices and a single community hospital, it is necessary to acknowledge the limitations in generalizability to Canadian population, and elsewhere. This was a retrospective study with non-random (i.e., convenience) sampling frame of patients and providers, and thereby the findings may not be generalizable externally (Jager et al, 2017).” That being said, to your point we have gone ahead and included in our Discussion section what can be learned from this study and transmitted to non-Canadian readers. Reviewer #2: Keywords: Much better to have keywords as Mesh term to make your research more popular. Please review and amend accordingly. Thank you. We have adjusted the keywords to be Mesh terms as per your suggestion. The new keywords are: Health Services, Primary Health Care, Referral and Consultation, Mental Health Services, Community Mental Health Services, and Cohort Studies. Abstract: Try to avoid first person pronouns when writing academic papers. I would suggest reviewing the method section in the abstract. Thank you. We have removed first person pronouns throughout the manuscript. Methodology: The Methods section provided in depth details. However, authors did not explain why they have selected such duration (2012-2019), was that based on a specific factor? We have been more specific about this in the manuscript as follows (methods, p.5): “The study timeframe was selected to include the maximum available follow up available in the HDC; the database includes data from January 1, 2012 – March 31, 2019.” Also, regarding common mental health diagnosis: why dual diagnosis was not part in this? Two different meanings of the term ‘dual diagnosis’ exist. In Canada, dual diagnosis often refers to the coexistence of one or more mental health problem with a developmental disability. In other jurisdictions such as the United States of America, dual diagnosis might refer to a psychiatric disorder along with, for example, a substance use issue. We interpreted your question about dual diagnosis to refer to the former which is applicable to the Canadian context. The reason for not including dual diagnosis in our list of common mental health diagnoses was because NYGH does not have a dual diagnosis clinic, and many other tertiary centres in the Greater Toronto Area (GTA) do, such as the Centre for Addiction and Mental Health (CAMH), Ontario Shores Centre for Mental Health Sciences and Surrey Place. Based on the experience of clinicians on our team we assessed that patients with dual diagnosis may already have a connection to one of these other hospitals, and would instead access acute medical or psychiatric care at those other hospitals. Discussion: The Discussion section is comprehensive. However, I was hoping to see more of other comparative trials from other places in the world when comparing the results to make sense of the reproducibility of the research. Thank you, we have provided additional details about related studies on this issue as follows (interpretation, p. 12): These findings about the use of specialty mental health care are similar to studies in other locations. For example, a study about health services use among people with mental health diagnoses in several large cities in the United States found about 20% of people accessed mental health specialty care over a several year period. not accessing specialty mental health care [33]. A similar proportion of use of specialized mental health services was identified among people with depression in Finland [34]. There are fewer descriptions of wait times for similar services in the existing literature, but available descriptions vary widely: a study in a US community health centre (primary care) setting described a wait time of 13 days for a psychiatric appointment [35]. Sincerely, Kimberly Lazare, MD, CCFP, MScCH Corresponding Author Attachments Attachment Submitted filename: Rebuttal Letter PLOS One Nov 18_KL_SK_BO_SK_KL.docx https://doi.org/10.1371/journal.pone.0266377.r002
21 Mar 2022 Decision Letter - Enkeleint A. Mechili, Editor Health system use among patients with mental health conditions in a community based sample in Toronto, Canada: A retrospective cohort study PONE-D-21-14663R1 Dear Dr. Lazare, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Enkeleint A. Mechili Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0266377.r003
Formally Accepted
28 Apr 2022 Acceptance Letter - Enkeleint A. Mechili, Editor PONE-D-21-14663R1 Health system use among patients with mental health conditions in a community based sample in Toronto, Canada: A retrospective cohort study Dear Dr. Lazare: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Enkeleint A. Mechili Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0266377.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .