Family physicians' experiences with community mental health centers: a multilevel analysis

The measurement of professionals' views of quality is a key component in the evaluation of health care delivery; however, few studies have assessed the feasibility of using such evaluations as quality indicators. The effects of individual and organizational factors on family physicians' experiences with community mental health centers were assessed by responses to a self-completed questionnaire and publicly available data.

Questionnaires were mailed in spring 2006 to family physicians in Norway for their evaluation of 71 community mental health centers; 2,120 (61%) practitioners responded. They evaluated centers on five scales: competence, discharge letter, contact with and help from the center in emergency situations, guidance from the center to practitioners, and workforce situation. Multilevel regression analyses were used to divide the variance between the two levels and to analyze associations with the five scales for individual- and center-level variables.

Center characteristics accounted for a substantial part of the variation; the intraclass correlation coefficient ranged from 10% for discharge letter to 23% for workforce situation. General impression of psychiatric services, knowledge of the center, negative episodes with the center, gender, and the center's location were significantly related to the scales. Explained variance at the individual level ranged from 24% for emergency situations to 38% for competence. Explained variance at the center level ranged from 40% for emergency situations to 70% for competence.

A substantial part of the variation at both levels was explained for all scales. Family physicians' evaluation of community mental health centers had substantial variation at the center level, supporting the use of such evaluations as quality indicators.