Draft invitation letter presented to focus groups.

Note this is the second version of the letter presented to the last three focus groups. (DOCX)</p

Characteristics of study participants.

For decades, researchers have used linkable administrative health data for evaluating the health care system, subject to local privacy legislation. In Ontario, Canada, the relevant privacy legislation permits some organizations (prescribed entities) to conduct this kind of research but is silent on their ability to identify and contact individuals in those datasets. Following consultation with the Office of the Information and Privacy Commissioner of Ontario, we developed a pilot study to identify and contact by mail a sample of people at high risk for kidney failure within the next 2 years, based on laboratory and administrative data from provincial datasets held by ICES, to ensure they receive needed kidney care. Before proceeding, we conducted six focus groups to understand the acceptability to the public and people living with chronic kidney disease of direct mail outreach to people at high risk of developing kidney failure. While virtually all participants indicated they would likely participate in the study, most felt strongly that the message should come directly from their primary care provider or whoever ordered the laboratory tests, rather than from an unknown organization. If this is not possible, they felt the health care provider should be made aware of the concern related to their kidney health. Most agreed that, if health authorities could identify people at high risk of a treatable life-threatening illness if caught early enough, there is a social responsibility to notify people. While privacy laws allow for free flow of health information among health care providers who provide direct clinical care, the proposed case-finding and outreach falls outside that model. Enabling this kind of information flow will require greater clarity in existing laws or revisions to these laws. This also requires adequate notification and culture change for health care providers and the public around information uses and flows.</div

Thematic summary of focus group findings.

For decades, researchers have used linkable administrative health data for evaluating the health care system, subject to local privacy legislation. In Ontario, Canada, the relevant privacy legislation permits some organizations (prescribed entities) to conduct this kind of research but is silent on their ability to identify and contact individuals in those datasets. Following consultation with the Office of the Information and Privacy Commissioner of Ontario, we developed a pilot study to identify and contact by mail a sample of people at high risk for kidney failure within the next 2 years, based on laboratory and administrative data from provincial datasets held by ICES, to ensure they receive needed kidney care. Before proceeding, we conducted six focus groups to understand the acceptability to the public and people living with chronic kidney disease of direct mail outreach to people at high risk of developing kidney failure. While virtually all participants indicated they would likely participate in the study, most felt strongly that the message should come directly from their primary care provider or whoever ordered the laboratory tests, rather than from an unknown organization. If this is not possible, they felt the health care provider should be made aware of the concern related to their kidney health. Most agreed that, if health authorities could identify people at high risk of a treatable life-threatening illness if caught early enough, there is a social responsibility to notify people. While privacy laws allow for free flow of health information among health care providers who provide direct clinical care, the proposed case-finding and outreach falls outside that model. Enabling this kind of information flow will require greater clarity in existing laws or revisions to these laws. This also requires adequate notification and culture change for health care providers and the public around information uses and flows.</div

Full interview guide for focus groups.

For decades, researchers have used linkable administrative health data for evaluating the health care system, subject to local privacy legislation. In Ontario, Canada, the relevant privacy legislation permits some organizations (prescribed entities) to conduct this kind of research but is silent on their ability to identify and contact individuals in those datasets. Following consultation with the Office of the Information and Privacy Commissioner of Ontario, we developed a pilot study to identify and contact by mail a sample of people at high risk for kidney failure within the next 2 years, based on laboratory and administrative data from provincial datasets held by ICES, to ensure they receive needed kidney care. Before proceeding, we conducted six focus groups to understand the acceptability to the public and people living with chronic kidney disease of direct mail outreach to people at high risk of developing kidney failure. While virtually all participants indicated they would likely participate in the study, most felt strongly that the message should come directly from their primary care provider or whoever ordered the laboratory tests, rather than from an unknown organization. If this is not possible, they felt the health care provider should be made aware of the concern related to their kidney health. Most agreed that, if health authorities could identify people at high risk of a treatable life-threatening illness if caught early enough, there is a social responsibility to notify people. While privacy laws allow for free flow of health information among health care providers who provide direct clinical care, the proposed case-finding and outreach falls outside that model. Enabling this kind of information flow will require greater clarity in existing laws or revisions to these laws. This also requires adequate notification and culture change for health care providers and the public around information uses and flows.</div

Counts of outpatient mental health and addiction–related codes by physicians during the first 18 months of the COVID–19 pandemic compared 3 years before the pandemic.

Counts of outpatient mental health and addiction–related codes by physicians during the first 18 months of the COVID–19 pandemic compared 3 years before the pandemic.</p

Poisson regression models comparing differences pre–COVID–19 and changes during COVID–19 pandemic in MHA visits between physicians and non–physicians.

Poisson regression models comparing differences pre–COVID–19 and changes during COVID–19 pandemic in MHA visits between physicians and non–physicians.</p

Age and sex standardized monthly rates of virtual and in–person outpatient MHA visits among physicians and non–physicians.

COVID–19, Coronavirus Disease 2019; MHA, mental health and addiction.</p

List of OHIP codes.

BackgroundThe Coronavirus Disease 2019 (COVID–19) pandemic has exacerbated mental health challenges among physicians and non–physicians. However, it is unclear if the worsening mental health among physicians is due to specific occupational stressors, reflective of general societal stressors during the pandemic, or a combination. We evaluated the difference in mental health and addictions health service use between physicians and non–physicians, before and during the COVID–19 pandemic.Methods and findingsWe conducted a population–based cohort study in Ontario, Canada between March 11, 2017 and August 11, 2021 using data collected from Ontario’s universal health system. Physicians were identified using registrations with the College of Physicians and Surgeons of Ontario between 1990 and 2020. Participants included 41,814 physicians and 12,054,070 non–physicians. We compared the first 18 months of the COVID–19 pandemic (March 11, 2020 to August 11, 2021) to the period before COVID–19 pandemic (March 11, 2017 to February 11, 2020). The primary outcome was mental health and addiction outpatient visits overall and subdivided into virtual versus in–person, psychiatrists versus family medicine and general practice clinicians. We used generalized estimating equations for the analyses.Pre–pandemic, after adjustment for age and sex, physicians had higher rates of psychiatry visits (aIRR 3.91 95% CI 3.55 to 4.30) and lower rates of family medicine visits (aIRR 0.62 95% CI 0.58 to 0.66) compared to non–physicians. During the first 18 months of the COVID–19 pandemic, the rate of outpatient mental health and addiction (MHA) visits increased by 23.2% in physicians (888.4 pre versus 1,094.7 during per 1,000 person–years, aIRR 1.39 95% CI 1.28 to 1.51) and 9.8% in non–physicians (615.5 pre versus 675.9 during per 1,000 person–years, aIRR 1.12 95% CI 1.09 to 1.14). Outpatient MHA and virtual care visits increased more among physicians than non–physicians during the first 18 months of the pandemic. Limitations include residual confounding between physician and non–physicians and challenges differentiating whether observed increases in MHA visits during the pandemic are due to stressors or changes in health care access.ConclusionsThe first 18 months of the COVID–19 pandemic was associated with a larger increase in outpatient MHA visits in physicians than non–physicians. These findings suggest physicians may have had larger negative mental health during COVID–19 than the general population and highlight the need for increased access to mental health services and system level changes to promote physician wellness.</div

Rates of outpatient health and addiction visits in psychiatrist physicians and non–psychiatrist physicians in the 36 months pre–pandemic (March 2017–February 2020) and during the first 18 months of the pandemic (March 2020–August 2021).

Rates of outpatient health and addiction visits in psychiatrist physicians and non–psychiatrist physicians in the 36 months pre–pandemic (March 2017–February 2020) and during the first 18 months of the pandemic (March 2020–August 2021).</p

Age and sex standardized monthly rates of outpatient MHA visits overall, to psychiatrists, and to family physicians among physicians and non–physicians.

Historic rates depict rates from March 2018 to August 2019. COVID–19, Coronavirus Disease 2019; MHA, mental health and addiction.</p