Heneghan Amy, Garner Andrew S, Storfer-Isser Amy, Kortepeter Karl, Stein Ruth E K, Horwitz Sarah McCue
Department of Pediatrics, School of Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH 44106, USA.
J Dev Behav Pediatr. 2008 Aug;29(4):262-9. doi: 10.1097/DBP.0b013e31817dbd97.
Many children who have a mental health disorder do not receive mental health services and are seen only in primary care settings. Perceptions of pediatricians and mental health specialists regarding the role that pediatricians should have in diagnosing and managing children's mental health problems have not been studied.
To examine whether primary care pediatricians (PCPs) and child and adolescent psychiatrists (CAPs) agree about: (1) the pediatrician's role in identification, referral, and treatment of childhood mental health (MH) disorders; and (2) barriers to the identification, referral, and treatment of childhood MH disorders.
Surveys were mailed in 2005 to 338 PCPs and 75 CAPs in 7 counties surrounding Cleveland, Ohio. Each group was asked whether they agreed that PCPs should be responsible for identifying, treating, or referring 7 prevalent childhood MH problems. Barriers that PCPs face in identification, referral, and treatment of MH problems were also assessed. Analyses were weighted for nonresponse; group differences were assessed via Rao-Scott chi test and weighted regression analyses.
Approximately half of PCPs and CAPs returned the survey. With the exception of attention deficit hyperactivity disorder (ADHD), the majority of PCPs and CAPs agreed that pediatricians should be responsible for identifying and referring, but not treating child MH conditions. For ADHD, PCPs were more likely than CAPs to agree that pediatricians should identify and treat affected children. PCPs were more likely than CAPs to agree that pediatricians should be responsible for identifying child/adolescent depression and anxiety disorders; the majority of both groups agree that PCPs should be responsible for referring, but not treating these conditions. Both groups agree that lack of MH services is a barrier to identification, treatment, and referral of child MH problems for PCPs. CAPs were more likely to agree that pediatrician's lack of training in identifying child mental health problems was a barrier, whereas PCPs were more likely to endorse lack of confidence in their ability to treat child MH problems with counseling, long waiting periods to see MH providers, family failure to follow through on referrals, and billing/reimbursement issues as barriers.
Most PCPs and CAPs believe it is pediatricians' responsibility to identify and refer, but not treat, the majority of children's mental health problems. Both groups agree that mental health services are not readily available. Future efforts are needed to support PCPs and CAPs in their combined effort to address the mental health needs of children.
许多患有精神健康障碍的儿童未接受精神健康服务，仅在初级保健机构就诊。儿科医生和精神健康专家对于儿科医生在诊断和管理儿童精神健康问题中应扮演的角色尚未进行研究。
探讨初级保健儿科医生（PCP）和儿童及青少年精神科医生（CAP）是否在以下方面达成共识：（1）儿科医生在儿童精神健康（MH）障碍的识别、转诊和治疗中的作用；（2）儿童MH障碍识别、转诊和治疗的障碍。
2005年向俄亥俄州克利夫兰市周边7个县的338名PCP和75名CAP邮寄了调查问卷。每组被问及是否同意PCP应负责识别、治疗或转诊7种常见的儿童MH问题。还评估了PCP在MH问题识别、转诊和治疗中面临的障碍。分析对无应答情况进行了加权处理；通过Rao-Scott卡方检验和加权回归分析评估组间差异。
约一半的PCP和CAP回复了调查。除注意力缺陷多动障碍（ADHD）外，大多数PCP和CAP同意儿科医生应负责识别和转诊，但不负责治疗儿童MH疾病。对于ADHD，PCP比CAP更有可能同意儿科医生应识别并治疗受影响的儿童。PCP比CAP更有可能同意儿科医生应负责识别儿童/青少年抑郁和焦虑障碍；两组中的大多数人都同意PCP应负责转诊，但不负责治疗这些疾病。两组都同意缺乏MH服务是PCP识别、治疗和转诊儿童MH问题的障碍。CAP更有可能同意儿科医生在识别儿童精神健康问题方面缺乏培训是一个障碍，而PCP更有可能认可对自己用咨询方法治疗儿童MH问题的能力缺乏信心、等待看MH提供者的时间过长、家庭未落实转诊以及计费/报销问题是障碍。
大多数PCP和CAP认为识别和转诊大多数儿童精神健康问题是儿科医生的责任，但不包括治疗。两组都同意精神健康服务不易获得。未来需要做出努力，支持PCP和CAP共同努力满足儿童的精神健康需求。
