Baum Rebecca A, Manda Divya, Brown Courtney M, Anzeljc Samantha A, King Melissa A, Duby John
Section of Developmental Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Ohio Health Grant Medical Center, Columbus, Ohio.
Pediatr Qual Saf. 2018 Oct 31;3(6):e119. doi: 10.1097/pq9.0000000000000119. eCollection 2018 Nov-Dec.
Pediatric primary care practitioners (PPCPs) report inadequate training in the care of children with common mental health conditions. Although additional training is needed, system changes are also necessary to support improvements in care.
We developed the Building Mental Wellness Learning Collaborative to assist PPCPs in delivering better mental health services in primary care by targeting 5 focus areas: mental health promotion; early identification and screening; practitioner skills; collaboration and community linkages; and medication management. Aims were developed for each area.
Twenty-one practices and 50 practitioners completed the collaborative in 2 seven-month waves. For mental health promotion, ≥85% of charts showed documentation in 3 of 4 preselected areas. For early identification/screening, screening increased, but the ≥85% goal was not met. For practitioner skills, a ≥20% increase in the proportion of children/youth ≥1 visits for anxiety or depression was achieved, from 0.70% of children/youth in the 12 months preintervention to 1.09% children/youth in the 12 months after. For collaboration/linkages, mental health referral completion was unchanged and below the 60% goal. For medication use, a ≥15% increase in selective serotonin reuptake inhibitor prescribing by Building Mental Wellness (BMW) practitioners was achieved from 0.72% children/youth with office visits pre-BMW to 0.92% post. Prescribing did not decrease for atypical antipsychotic medication use or for psychotropic medication use in children younger than 6 years, although there was a trend toward more appropriate prescribing.
The BMW Learning Collaborative was effective in helping PPCPs implement certain aspects of a comprehensive approach to the delivery of mental health services in primary care.
儿科初级保健从业者（PPCP）报告称，在照顾患有常见心理健康问题的儿童方面，他们接受的培训不足。尽管需要额外的培训，但系统变革对于支持护理改善也是必要的。
我们开发了“构建心理健康学习协作项目”，以帮助PPCP在初级保健中提供更好的心理健康服务，目标集中在五个领域：心理健康促进；早期识别与筛查；从业者技能；协作与社区联系；以及药物管理。为每个领域制定了目标。
21家医疗机构和50名从业者分两批，每批为期七个月，完成了该协作项目。在心理健康促进方面，≥85%的病历在4个预选领域中的3个领域有记录。在早期识别/筛查方面，筛查有所增加，但未达到≥85%的目标。在从业者技能方面，≥1岁儿童/青少年因焦虑或抑郁就诊的比例增加了≥20%，从干预前12个月的0.70%增加到干预后12个月的1.09%。在协作/联系方面，心理健康转诊完成率没有变化，低于60%的目标。在药物使用方面，“构建心理健康”（BMW）从业者开具的选择性5-羟色胺再摄取抑制剂增加了≥15%，从BMW项目开展前因就诊而开具该药物的儿童/青少年比例0.72%增加到之后的0.92%。对于非典型抗精神病药物的使用或6岁以下儿童使用精神药物的情况，开具量没有减少，尽管有更合理开具的趋势。
BMW学习协作项目有效地帮助PPCP在初级保健中实施了全面心理健康服务方法的某些方面。
