Do Pediatricians Think They Should Care For Patients with New Morbidity? Results of the AAP Periodic Survey

Ruth E.K. Stein, MD, Sarah McCue Horwitz, PhD, Robert B. Penfold, PhD, Lynn Olson, PhD, Kelly Kelleher, MD, Amy Heneghan, MD, Elyse Park, PhD, Kimberly Hoagwood, MD.

 

Background:  Little is known about what pediatricians think about treating behavioral issues.

 

Objective: To test hypotheses that pediatricians who a) rate MH issues as more prevalent, b) think that the issues have larger effects on physical and on mental health (MH) or c) trained more recently are more likely to identify, treat or refer; and that they do so more for children (C) than for their mothers (M).

 

Design/Methods: AAP Periodic Survey #59, a random sample of 1600 members.  57% of non-trainee members responded (N=745).  Categorical regression models were used to test hypotheses.

 

Results: Most pediatricians agree they should be responsible for identifying both C and M morbidity.  They are most likely to agree (>80%) for ADHD, eating disorders, C depression, C SA, behavior problems and hostile rejecting parenting and least likely to agree for learning problems.  M substance abuse (SA) and M depression (56-57%).  66% think pediatricians should treat or manage ADHD; but for all other conditions most thought their responsibility was to refer.  In practice few usually inquire about conditions surveyed except for ADHD, M smoking, and C SA (61-57%).  Few report they usually treat, except ADHD 54%; only 16% treat depression (next highest).  <1/3 usually ask about domestic violence, M depression, caregiving, or hostile parenting.  Those who perceived MH issues to be more prevalent and to have greater impact on MH were significantly (p<.001) more likely to inquire about C issues, adj R²=.34.  Along with concern about effects on physical health, these variables accounted for 39% of the variance in referral and 14% in treatment.  The same factors significantly (p<.001) contributed to inquiring, referring and treating Ms? problems, but explained less variance (12%; 9%; and 6% respectively).  Among those who considered conditions prevalent, treatment was ≥2 times as frequently for all problems except ADHD (1.4 times)(all P<.001).  More recently trained MDs were NOT more likely to treat conditions.

 

Conclusions: These data suggest that pediatricians think they should identify, treat and refer more patients and their moms for MH issues than they are.  Given the large unmet needs in these areas it is important to understand the gaps between what they believe and do.