McCue Horwitz Sarah, Storfer-Isser Amy, Kerker Bonnie D, Szilagyi Moira, Garner Andrew S, O'Connor Karen G, Hoagwood Kimberly E, Green Cori M, Foy Jane M, Stein Ruth E K
Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
Statistical Research Consultants, LLC, Schaumburg, Ill.
Acad Pediatr. 2016 Sep-Oct;16(7):676-83. doi: 10.1016/j.acap.2016.03.010. Epub 2016 Apr 6.
To assess the availability of on-site mental health professionals (MHPs) in primary care; to examine practice/pediatrician characteristics associated with on-site MHPs; and to determine whether the presence of on-site MHPs is related to pediatricians' comanaging or more frequently identifying, treating/managing, or referring mental health (MH) problems.
Analyses included American Academy of Pediatrics (AAP) members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (n = 321). Measures included sociodemographics, practice characteristics, questions about on-site MHPs, comanagement of MH problems, and pediatricians' behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate, and multivariable analyses were performed.
Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools, universities, health maintenance organizations, <100 visits per week, <80% of patients privately insured) and interactions of practice location (urban) with visits and patient insurance were associated with on-site MHPs. There was no overall association between colocation and comanagement, or whether pediatricians usually identified, treated/managed, or referred 5 common child MH problems. Among the subset of pediatricians who reported comanaging, there was an association with comanagement when the on-site MHP was a child psychiatrist, substance abuse counselor, or social worker.
On-site MHPs are more frequent in settings where low-income children are served and where pediatricians train. Pediatricians who comanage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, substance abuse counselor, or social worker. Overall, on-site MHPs were not associated with comanagement or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems.
评估初级保健机构中现场心理健康专业人员（MHP）的可获得性；研究与现场MHP相关的执业/儿科医生特征；并确定现场MHP的存在是否与儿科医生共同管理或更频繁地识别、治疗/管理或转诊心理健康（MH）问题有关。
分析纳入了2013年参加美国儿科学会（AAP）定期调查且从事普通儿科工作的AAP成员（n = 321）。测量指标包括社会人口统计学、执业特征、关于现场MHP的问题、MH问题的共同管理以及儿科医生对5种常见MH问题的应对行为。进行了加权单变量、双变量和多变量分析。
35%的人报告有现场MHP。执业特征（医学院校、大学、健康维护组织、每周就诊次数<100次、<80%的患者为私人保险）以及执业地点（城市）与就诊次数和患者保险的相互作用与现场MHP相关。现场办公与共同管理之间，以及儿科医生是否通常识别、治疗/管理或转诊5种常见儿童MH问题之间没有总体关联。在报告进行共同管理的儿科医生子集中，当现场MHP是儿童精神科医生、药物滥用顾问或社会工作者时，与共同管理存在关联。
在为低收入儿童服务的机构以及儿科医生接受培训的机构中，现场MHP更为常见。当现场MHP是儿童精神科医生、药物滥用顾问或社会工作者时，共同管理MH问题的儿科医生更有可能这样做。总体而言，现场MHP与共同管理或儿科医生识别、治疗/管理或转诊患有5种常见儿童MH问题的儿童的可能性增加无关。
