Primary Care Treatment of Pediatric Psychosocial Problems: A Study From Pediatric Research in Office Settings and Ambulatory Sentinel Practice Network

Abstract

Objective. Psychosocial problems cause much of the morbidity among children, and their frequency of presentation in primary care is growing. How is primary care treatment of children's psychosocial problems affected by child symptoms, physician training, practice structure, insurance, physician/patient relationship, and family demographics? Design. Questionnaire study of treatment of psychosocial problems during office visits by children. Settings. At total of 401 primary care offices from 44 US states, Puerto Rico, and Canada. Patients. From 21 150 children seen in office visits, we selected children with an identified psychosocial problem but who were not already receiving specialty mental health services (n = 2618 children). Outcome Measures. Clinicians' decisions to counsel families, to refer children to mental health specialists, or to prescribe medication. Results. The treatment choices of primary care clinicians (PCCs) were generally independent of patients' demographics or insurance status. Clinicians' training, beliefs about mental health, and practice structure had no effect on treatment choices. However, clinicians seeing their own patients were more likely to prescribe medications for attention problems. The clinician's perception about whether the parent agreed with the treatment choice was important for every treatment modality. Counseling and referral were more common and medication was less common when a problem was newly recognized at the visit. Conclusions. Structural factors such as practice type, insurance coverage, and physician training were less important for treatment than were process factors, such as whether the visit was a psychosocial problem visit, whether the problem was newly or previously recognized, and whether the family and clinician were familiar with each other and in accord about treatment.