In-Office Primary Care Management of Child Psychosocial Problems • 58

Abstract

To examine the primary care management of child psychosocial problems and the patient, provider and insurance correlates of management. Questionnaires were completed by 401 clinicians from 44 states, Puerto Rico, and 4 Canadian provinces from two primary care research networks and by families of consecutive children aged 4-15 years presenting for non-emergent care. For children identified with a psychosocial problem, clinicians described interventions including drug prescriptions, counseling in the office and visit disposition. Treatment choices were modeled both independently and simultaneously. Complete data on 21,151 visits were analyzed. 19.0% (n=4,012) were identified by clinicians with a psychosocial problem. Among these, 24% received no medications, counseling or followup visits (41% of these were already in specialty mental health services). Of children with psychosocial problems, 10% were scheduled for an additional visit to address the problem, but received no other interventions. The remaining children with psychosocial problems received counseling only (22%), a psychotropic prescription only(29%), or both (15%). Children with commercial (vs public or no) insurance, younger females and those children seen for parental psychosocial concerns were more likely to receive counseling. Children were more likely to receive psychotropic medications if older, male, severe, or visited during the school year. Receipt of specialty services and visits for acute or chronic medical problems were associated with lower rates of drug prescriptions. When modeled simultaneously, clinician identification of attentional and hyperactivity problems was the best predictor of clinician intervention. Psychosocial problems are commonly managed in primary care. Counseling and/or psychotropic drugs are provided to 2/3 of all identified patients, but considerable variation exists in management. Development of guidelines or protocols for management for these common and high cost problems should be a priority.