Boston University School of Public Health, Boston, Massachusetts.
Departments of Pediatrics.
Pediatrics. 2022 Apr 1;149(4). doi: 10.1542/peds.2021-051822.
Research supports integrated pediatric behavioral health (BH), but evidence gaps remain in ensuring equitable care for children of all ages. In response, an interdisciplinary team codeveloped a stepped care model that expands BH services at 3 federally qualified health centers (FQHCs).
FQHCs reported monthly electronic medical record data regarding detection of BH issues, receipt of services, and psychotropic medications. Study staff reviewed charts of children with attention-deficit/hyperactivity disorder (ADHD) before and after implementation.
Across 47 437 well-child visits, >80% included a complete BH screen, significantly higher than the state's long-term average (67.5%; P < .001). Primary care providers identified >30% of children as having BH issues. Of these, 11.2% of children <5 years, 53.8% of 5-12 years, and 74.6% >12 years were referred for care. Children seen by BH staff on the day of referral (ie, "warm hand-off") were more likely to complete an additional BH visit than children seen later (hazard ratio = 1.37; P < .0001). There was no change in the proportion of children prescribed psychotropic medications, but polypharmacy declined (from 9.5% to 5.7%; P < .001). After implementation, diagnostic rates for ADHD more than doubled compared with baseline, follow-up with a clinician within 30 days of diagnosis increased (62.9% before vs 78.3% after; P = .03) and prescriptions for psychotropic medication decreased (61.4% before vs 43.9% after; P = .03).
Adding to a growing literature, results demonstrate that integrated BH care can improve services for children of all ages in FQHCs that predominantly serve marginalized populations.
研究支持儿科行为健康（BH）的综合治疗，但仍存在确保所有年龄段儿童获得公平医疗服务的证据缺口。为应对这一挑战，一个跨学科团队共同制定了一个阶梯式护理模式，在 3 家联邦合格的健康中心（FQHC）扩大 BH 服务。
FQHC 每月报告电子病历数据，包括 BH 问题的检测、服务的获得和精神类药物的使用情况。研究人员在实施前后审查了患有注意力缺陷/多动障碍（ADHD）的儿童的病历。
在 47437 次常规儿童保健就诊中，超过 80%的儿童接受了完整的 BH 筛查，显著高于该州的长期平均水平（67.5%；P<0.001）。初级保健提供者确定了超过 30%的儿童存在 BH 问题。其中，11.2%的<5 岁儿童、53.8%的 5-12 岁儿童和 74.6%的>12 岁儿童被转介接受治疗。在转介当天由 BH 工作人员接诊的儿童（即“温暖交接”）比稍后接诊的儿童更有可能完成额外的 BH 就诊（风险比=1.37；P<0.0001）。儿童接受精神类药物治疗的比例没有变化，但药物联合使用减少（从 9.5%降至 5.7%；P<0.001）。实施后，与基线相比，ADHD 的诊断率增加了一倍以上，诊断后 30 天内与临床医生的随访增加（之前为 62.9%，之后为 78.3%；P=0.03），精神类药物的处方减少（之前为 61.4%，之后为 43.9%；P=0.03）。
除了越来越多的文献外，这些结果表明，在主要为弱势群体服务的 FQHC 中，综合 BH 护理可以改善所有年龄段儿童的服务。
