INSURANCE STATUS AND RECOGNITION OF PSYCHOSOCIAL PROBLEMS - A REPORT FROM THE PEDIATRIC RESEARCH IN OFFICE SETTINGS AND THE AMBULATORY SENTINEL PRACTICE NETWORKS

Objective: To examine the effect of insurance status on clinician reco gnition of psychosocial problems for pediatric primary care visits. De sign: A cohort study of 10 250 visits by children 4 to 15 years old fo r nonemergent care. Setting: Two large primary care research networks reported data from 172 primary care clinicians in office-based practic e. Patients: Ten thousand two hundred and fifty unique children presen ting consecutively to participating physicians for nonemergent service s with a parent or caregiver. Main Outcome Measure: Children were clas sified as positive for psychosocial problems if their score on the par ent-reported Pediatric Symptom Checklist exceeded the standard cutoff of 28. Clinician recognition was obtained by report as a dichotomous v ariable. Insurance status was categorized by payor and plan structure. Results: Clinicians did not recognize psychosocial problems for a sub stantial number of children with scores suggestive of marked psychosoc ial dysfunction on the Pediatric Symptom Checklist. Insurance type was not associated with rates of recognition. However, provider familiari ty with patients, provider discipline, and patient demographics were a ssociated with increased recognition of psychosocial problems. Conclus ions: Differences in treatment among various insurance groups document ed in prior studies are not likely to be related to varying recognitio n rates, but rather to availability and choices of treatment by insure rs, families, and clinicians. Continuity of care was the strongest pre dictor of clinician recognition.