Nationwide Children's Hospital, Ohio State University, Columbus, Ohio (Baum); People's Health Solutions, Los Angeles (King); Johns Hopkins Hospital and Health System, Baltimore (Wissow).
Psychiatr Serv. 2019 Feb 1;70(2):123-129. doi: 10.1176/appi.ps.201800163. Epub 2018 Dec 10.
Mental health concerns are common in pediatric primary care, but practitioners report low levels of comfort managing them. A primary care intervention addressing organizational and individual factors was developed to improve the management of common mental health conditions.
Twenty-nine practices participated in a statewide learning collaborative over 18 months. On-site training was used to teach communication and brief intervention skills and develop an organizational context supportive of mental health. Clinician confidence was measured pre- and postintervention. Medicaid claims data were used to estimate the intervention's effects on identification of mental health conditions and prescribing practices.
Mean clinician confidence scores increased by 20% (95% confidence interval [CI]=15% to 25%), from 2.92 at baseline to 3.55 postintervention. In the first month of the preintervention year, 6.65% of patients with an office visit had at least one visit for a mental health condition, rising to 9% postintervention; this trend was driven by detection and treatment of attention-deficit hyperactivity disorder (ADHD). Rates of prescribing ADHD medication to patients with visits for ADHD increased by 0.12 percentage points per month (CI=0.02 to 0.22, p=0.022). Rates of prescribing second-generation antipsychotics to all patients with office visits decreased by 0.014 percentage points per month (CI=-.03 to -.00, p=0.028), relative to preintervention trends.
This study suggests that a multicomponent intervention addressing individual staff and organizational factors together can promote identification and treatment of child mental health conditions in primary care. Future research is required to better understand the core components, impact on health outcomes, and sustainability.
儿童初级保健中常见心理健康问题，但从业者报告管理这些问题的舒适度较低。开发了一项初级保健干预措施，以解决组织和个人因素，以改善常见心理健康状况的管理。
29 家实践参与了为期 18 个月的全州学习合作。现场培训用于教授沟通和简短干预技巧，并为支持心理健康的组织环境。在干预前后测量临床医生的信心。使用医疗补助索赔数据来估计干预对识别心理健康状况和处方实践的影响。
临床医生信心平均得分提高了 20%（95%置信区间[CI]为 15%至 25%），从基线时的 2.92 提高到干预后的 3.55。在干预前一年的第一个月，6.65%的就诊患者至少有一次就诊的精神健康状况，上升到干预后的 9%；这一趋势是由注意力缺陷多动障碍（ADHD）的检测和治疗推动的。ADHD 就诊患者服用 ADHD 药物的处方率每月增加 0.12 个百分点（CI=0.02 至 0.22，p=0.022）。与干预前的趋势相比，所有就诊患者的第二代抗精神病药物处方率每月降低 0.014 个百分点（CI=-.03 至-.00，p=0.028）。
这项研究表明，一项针对个人员工和组织因素的多组分干预措施可以共同促进初级保健中儿童心理健康状况的识别和治疗。需要进一步研究以更好地了解核心成分、对健康结果的影响和可持续性。
