Data sources

Data for the study were collected from the Régie d’Assurance Maladie du Québec (RAMQ), the Quebec healthcare insurance databanks which contain medical administrative information including billing files for medical services provided by physicians. These files cover most outpatient medical activities as only 6% of physician billing occurs outside of the public system [28]. The RAMQ also integrates demographic and socioeconomic information, including material and social deprivation indices [29]. Other data included the hospitalization/discharge databank (Maintenance et exploitation de données pour l’étude de la clientèle hospitalière: MED-ECHO) and the Quebec emergency databank (Banque de données commune des urgences: BDCU), adding pertinent complementary information (e.g., having a family physician or not, illness acuity, patient reasons for visiting ED as evaluated by triage nurses). Finally, the local community health service center databank (Système d’information clinique et administrative des centres locaux de services communautaires) provided additional data on biopsychosocial services offered by the Quebec public primary care system, including medical interventions provided by salaried general practitioners (GP) and primary care MH services.