Psychiatry Research Profile: Bentson McFarland, M.D., Ph.D.
ACCESS TO HIGH QUALITY behavioral health care for all in need is Bentson McFarland’s goal in the research, education, and clinical service programs he directs. Dr. McFarland, Professor of Psychiatry, Public Health and Preventive Medicine, says “Our so-called health care system is dysfunctional, disintegrating, and desperately needs to be replaced. But major changes are unlikely any time soon. Consequently, as clinicians we must provide the best service we can with the limited resources available. The purpose of the Gaines Hall research and training program is to facilitate provision of services that help people maintain or regain health. Our activities focus on behavioral health services such as treatments for people with substance abuse problems. Our projects include studies evaluating quality of care, access to services, and the impact of financial arrangements on delivery of care.”
Dr. McFarland spends about a third of his time seeing patients ranging from adolescents to the elderly. Most of his activities, however, are devoted to research on the health care system – learning what works, measuring the impact of managed care on access to behavioral health services, examining the effectiveness of treatments for alcohol and drug abuse, and studying the influence of organizational and financial arrangements on the use of behavioral health services.
For example, a recent study on health status garnered national attention. Using international health survey data, Mark Kaplan , Jason Newsom, Nathalie Huguet (all of Portland State University) and Dr. McFarland, found that while Americans spend twice as much on health care as Canadians or Europeans, we are more likely to rate our health as fair or poor. The differences in self-rated health between the United States and the other countries began at age 30 and increased with age. The researchers wrote, “Overall, Canadians and Europeans spend about half of what Americans spend on health care yet feel better in nearly all age categories.” They concluded, “Our study confirms and complements earlier research indicating that the expensive and technologically advanced healthcare system in the U.S. does not yield population health outcomes comparable to those in countries with much lower spending whether measured per capita or as a percentage of gross domestic product (GDP). Unequal and uncoordinated provision of care along with other inefficiencies in the U.S. health system may explain why Americans spend more but feel worse.” (Journal of Epidemiology and Community Health 2004; 58:529-530).
Dr. McFarland says he was always drawn to research, “From an early age, I was very interested in posing and answering questions about how the world operates.” His interest in science led him to study biochemistry at Yale, biology at the California Institute of Technology in Pasadena, and then medicine at the University of Washington. In medical school, he had an excellent mentor during his psychiatry rotation who inspired and encouraged his growing interest in behavioral health. He went on to earn a Ph.D. in biostatistics at the University of Washington, before joining the residency training program in psychiatry at OHSU (1979-83). His training included a two-year fellowship in geriatric psychiatry and psychiatric epidemiology (1983-85) at Maudsley Hospital and the University of London.
He returned to Portland in 1985 to join the OHSU faculty as an assistant professor. He also served as a staff psychiatrist at St. Vincent Hospital and Cedar Hills Hospital, and began continuing consultations to Mental Health Services West / Cascadia Behavioral Care, Multnomah County, the State of Oregon Office of Mental Health and Addictions Services, Oregon State Hospital, and the Portland Veterans Affairs Medical Center. He was the director of Emergency Psychiatric Services at OHSU from 1986-88. At the same time, he became an adjunct investigator at the Kaiser Permanente Center for Health Research (1986 to present). Dr. McFarland was appointed Associate Professor of Psychiatry and Public Health and Preventive Medicine at OHSU in 1990, and in 1996, he was promoted to full professor. He received a courtesy appointment as Professor from the Oregon State University College of Pharmacy in 1998. In 2001, he joined the Oregon Research Institute in Eugene as a Senior Scientist.
At the same time, he has taught in the Public Psychiatry Training Program leading seminars on the organization of behavioral health services and on psychiatric epidemiolgy. He also teaches in the Public Health and Preventive Medicine residency program and in the Master of Public Health program.
Over the years, McFarland has been first-author for over 73 peer-reviewed journal articles and has co-authored more than 160 papers. His curriculm vitae lists 170 abstracts and presentations on topics including the effects of system changes on the costs of civil commitment, how Health Maintenance Organization membership effects use of mental health services by the elderly, homelessness and mental illness, capitation and the severely mentally ill, state regulation of prescribed medications, prioritizing mental health services, and substance abuse and managed care.
Research for Dr. McFarland is not a solitary pursuit. His work takes place largely at Gaines Hall at OHSU where he says “one of the most gratifying aspects of the last several years has been assembling a group of people who are very skilled and very congenial.” The focus of their recent research has been use of large automated databases (including state alcohol and drug abuse data, police and corrections information, and Medicaid records) to examine patterns of care and treatment outcomes. Dr. McFarland says, “The folks at Gaines Hall have years of experience with advanced statistical techniques that can be used to tease out the maximum amount of information from complicated, large scale, longitudinal administrative data sets. We’ve also been supporting the State of Oregon in its efforts to link administrative databases. That complex administrative data structure will be an invaluable resource for future evaluation and research projects.”
His current studies include collaboration with the researchers at RMC Research Corporation comparing the organization, financing, and outcomes of methadone maintenance programs in Oregon and Washington. He is also working with the One Sky Center at OHSU on projects designed to improve prevention and treatment of substance abuse in the American Indian and Alaska Native population. His work with the Oregon Research Institute is also in the area of improving quality of care within the public sector of substance abuse treatment. At OHSU he has support from the Robert Wood Johnson Foundation to study ways to improve care for people who have both mental health and substance abuse problems. According to Dr. McFarland, “Portland has a nationally-recognized capability for substance abuse research. We have everything from behavioral molecular genetics at the Portland Alcohol Research Center to service system studies at the Department of Public Health and Preventive Medicine. There’s a large chemical dependency economics research program at the Kaiser Permanente Center of Health Research. In the OHSU Department of Psychiatry there is substantial capability to study the multi-cultural aspects of substance abuse prevention and treatment with the One Sky Center and also the Center for American Indian Health Education Research.”
Dr. McFarland is willing, even eager, to help others. He has served as a thesis advisor for the Master of Public Health Program since 1995. He also collaborates with younger faculty researchers in several departments and received the Department of Psychiatry Leadership Award in 2004 for Mentoring Residents and Colleagues. Dr. McFarland says, “Mentoring is probably the most useful and also one of the most enjoyable things I do.”
He enthusiastically recommends that new researchers (and experienced ones, too) take advantage of the resources available through the Gaines Hall Research Support Group. Says Dr. McFarland, “The Gaines Hall staff have considerable skills and experience in negotiating both the university bureaucracy and the funding agencies’ bureaucracies. They can assemble and submit grant applications and they know how to manage the money once the funding arrives.”
Asked about future opportunities in psychiatry research, he replied, “There will be continued emphasis on measuring quality of care and on finding ways to facilitate provision of high quality services. At the system level, I think we need to investigate how we can use the finance mechanism to motivate providers, and for that matter, consumers to deliver or obtain the highest quality services possible. Further down the road, it’s conceivable that molecular medicine and new imaging methods may eventually have clinical utility. This very expensive technology will stimulate a whole generation of research to understand how these new methodologies can best be used in an environment of limited resources.”
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