Department of Medicine, University of Pittsburgh School of Medicine (EA McGuier), Pittsburgh, Pa.
Department of Psychiatry, University of Pittsburgh School of Medicine (DJ Kolko), Pittsburgh, Pa.
Acad Pediatr. 2020 Apr;20(3):399-404. doi: 10.1016/j.acap.2019.11.008. Epub 2019 Nov 21.
Pediatric primary care providers (PCPs) are increasingly expected to deliver behavioral health (BH) services, yet PCP characteristics that facilitate or hinder BH service delivery are poorly understood. This study examined how PCP characteristics and collaborative care participation influenced changes in BH-related effort and competency over time.
Pediatric PCPs (N = 74) participating in a cluster randomized trial (8 practices) of a collaborative care intervention for disruptive behavior problems completed self-report measures at 0, 6, 12, and 18 months. Latent growth curve models tested the impact of PCP characteristics (ie, age, gender, negative BH beliefs, BH burden, BH competency) on changes in identification/treatment of disruptive behavior disorders and competency over the course of the trial.
Participation in collaborative care was associated with increases in identification/treatment, with no evidence that PCP characteristics moderated changes in identification/treatment. For competency, however, older PCPs (>50 years) in collaborative care exhibited steep increases over time, while older PCPs in the comparison condition exhibited steep decreases, suggesting differential benefits of collaborative care participation by PCP age. In both conditions, PCPs with more negative BH beliefs reported less identification/treatment over time. Baseline competency was positively associated with identification/treatment and associations weakened over time. Gender and perceived burden had little impact.
PCP characteristics are associated with changes in PCPs' BH-related effort and competency over time. Participation in a collaborative care model appears to be especially beneficial for older PCPs. Implementation of collaborative care can promote growth in BH-related effort and competency for PCPs.
儿科初级保健提供者（PCP）越来越被期望提供行为健康（BH）服务，但促进或阻碍 BH 服务提供的 PCP 特征知之甚少。本研究考察了 PCP 特征和参与合作护理如何影响 BH 相关工作和能力随时间的变化。
参与破坏性行为问题合作护理干预的儿科 PCP（N=74）参加了一项集群随机试验（8 个实践），在 0、6、12 和 18 个月时完成了自我报告的措施。潜在增长曲线模型测试了 PCP 特征（即年龄、性别、负面 BH 信念、BH 负担、BH 能力）对识别/治疗破坏性行为障碍和试验过程中能力变化的影响。
参与合作护理与识别/治疗的增加有关，没有证据表明 PCP 特征调节了识别/治疗的变化。然而，对于能力，合作护理中的老年 PCP（>50 岁）随着时间的推移表现出急剧增加，而对照组中的老年 PCP 表现出急剧下降，这表明合作护理参与对 PCP 年龄有不同的益处。在两种情况下，具有更多负面 BH 信念的 PCP 报告随着时间的推移，识别/治疗的次数越少。基线能力与识别/治疗呈正相关，随着时间的推移，相关性减弱。性别和感知负担影响不大。
PCP 特征与 PCP 随时间变化的 BH 相关工作和能力有关。参与合作护理模式似乎对老年 PCP 特别有益。合作护理的实施可以促进 PCP 对 BH 相关工作和能力的增长。
