Wildman B G, Kinsman A M, Logue E, Dickey D J, Smucker W D
Department of Psychology, Kent State University, OH 44242, USA.
J Fam Pract. 1997 Jan;44(1):77-84.
Between 15% and 25% of children who visit primary care physicians have emotional, behavioral, or psychiatric problems that affect their functioning. The majority of these children are treated by primary care physicians. The purpose of this study was to examine the presentation and treatment of children's psychosocial problems in primary care and to investigate ways in which physician management of a problem is related to parent-physician agreement that the problem exists.
Twenty-six physicians at an ambulatory care center of a community-based, university-affiliated family medicine training program collected data during outpatient visits of 898 children aged 2 to 16 years. The physicians used a checklist to collect data on children's developmental problems, parents' concerns about the psychosocial functioning of their children, whether physicians and parents were in agreement about these concerns, and the parents' influence on physicians' management of the problems.
Family physicians and parents agreed that 10% of the children were experiencing psychosocial problems. For 5% of children, physicians recorded emotional or behavioral concerns when parents did not disclose any such concerns. For only 1.8% of children, parents raised psychosocial concerns while physicians did not. Physicians diagnosed and managed psychosocial concerns during both acute-care and well-child visits. When parents and physicians agreed on the presence of pediatric psychosocial problems, referral to a mental health professional was more likely than when they disagreed (60% vs 16%).
Pediatric psychosocial concerns are raised by parents during acute-care and well-child visits. Family physicians identified and managed these problems at rates consistent with past research. Management strategies appeared to differ as a function of agreement between physicians and parents on whether a problem existed.
在前往初级保健医生处就诊的儿童中，15%至25%存在影响其功能的情绪、行为或精神问题。这些儿童中的大多数由初级保健医生进行治疗。本研究的目的是检查初级保健中儿童心理社会问题的表现和治疗情况，并调查医生对问题的处理方式与家长和医生就问题存在达成共识之间的关系。
在一个以社区为基础、与大学相关的家庭医学培训项目的门诊护理中心，26名医生在898名2至16岁儿童的门诊就诊期间收集数据。医生使用一份清单收集有关儿童发育问题、家长对其子女心理社会功能的担忧、医生和家长是否就这些担忧达成共识以及家长对医生处理问题的影响的数据。
家庭医生和家长一致认为10%的儿童存在心理社会问题。对于5%的儿童，当家长未透露任何此类担忧时，医生记录了情绪或行为方面的担忧。只有1.8%的儿童，家长提出了心理社会方面的担忧而医生未提及。医生在急性病护理和健康儿童就诊期间都诊断并处理了心理社会方面的担忧。当家长和医生就儿科心理社会问题的存在达成共识时，转诊至心理健康专业人员的可能性比他们意见不一致时更高（60%对16%）。
家长在急性病护理和健康儿童就诊期间提出了儿科心理社会方面的担忧。家庭医生识别并处理这些问题的比例与过去的研究一致。管理策略似乎因医生和家长就问题是否存在达成的共识不同而有所差异。
