W. Gardner et al., Primary care treatment of pediatric psychosocial problems: A study from pediatric research in office settings and ambulatory sentinel practice network, PEDIATRICS, 106(4), 2000, pp. NIL_1-NIL_9
Objective. Psychosocial problems cause much of the morbidity among children
, and their frequency of presentation in primary care is growing. How is pr
imary care treatment of children's psychosocial problems affected by child
symptoms, physician training, practice structure, insurance, physician/pati
ent relationship, and family demographics?
Design. Questionnaire study of treatment of psychosocial problems during of
fice visits by children.
Settings. At total of 401 primary care offices from 44 US states, Puerto Ri
co, and Canada.
Patients. From 21 150 children seen in office visits, we selected children
with an identified psychosocial problem but who were not already receiving
specialty mental health services (n = 2618 children).
Outcome Measures. Clinicians' decisions to counsel families, to refer child
ren to mental health specialists, or to prescribe medication.
Results. The treatment choices of primary care clinicians (PCCs) were gener
ally independent of patients' demographics or insurance status. Clinicians'
training, beliefs about mental health, and practice structure had no effec
t on treatment choices. However, clinicians seeing their own patients were
more likely to prescribe medications for attention problems. The clinician'
s perception about whether the parent agreed with the treatment choice was
important for every treatment modality. Counseling and referral were more c
ommon and medication was less common when a problem was newly recognized at
the visit.
Conclusions. Structural factors such as practice type, insurance coverage,
and physician training were less important for treatment than were process
factors, such as whether the visit was a psychosocial problem visit, whethe
r the problem was newly or previously recognized, and whether the family an
d clinician were familiar with each other and in accord about treatment.