American Academy of Pediatrics
Division of Health Policy Research
ABSTRACT
Presented at the Pediatric Academic Societies annual meeting, May 2005
Barriers to the Identification and Management of Mental
Health Issues in Pediatric Primary Care
Sarah
M Horwitz, PhD 1, Kelly J Kelleher, MD 2, Ruth EK Stein, MD 3 and et al. 4. 1 Epi/Bio, Case, Cleveland,
OH, 44106; 2 Pediatrics, OSU, Columbus, OH, 43205 and
3 Pediatrics, AECOM/CHAM, Bronx, NY.
Background: Child and mother mental health (MH) issues are
often not identified or managed in pediatric primary care. Although there
has been some research on the barriers to optimal practice for these problems,
a comprehensive examination of barriers across multiple child and maternal
issues guided by a clear conceptual model is not available.
Objective: To determine whether: (1) perceived barriers to
care for MH issues aggregate into patient, physician and system-areas; and
(2) physician, patient and practice characteristics are associated with different
types of barriers for children and mothers.
Design/Methods: AAP Periodic Survey 59 fielded in 2004 randomly
sampled 1600 pediatrician members. Of the 1294 non-trainees, 745 or 57.5%
responded. Responses to questions on perceived barriers were factor analyzed
and resulting scales were used as dependent variables in the logistic regression
analyses. Since responders were more likely to be female and younger, all
analyses were weighted.
Results: 55.5% of the sample is female, 40.5% is <
39 years of age, 71.1% identify themselves as white, 40.1% of the sample had
been in practice for < 9 years, 231 or 33.6% had a mental health-related
fellowship and 687 or 92% reported that they were involved in direct patient
care. Factor analyses showed 5 unique clusters of barriers: physician inadequacies
in identification management (IM) for children and for mothers; maternal issues;
systems issues for children and for mothers. Physician inadequacies for IM
in children were related to providing MH services, fellowship-level training
in MH, while no physician or patient characteristics distinguished pediatricians
IM for mothers.
Physicians who did not provide MH care, who had no MH-related fellowship and
who practiced in rural areas saw maternal issues as barriers. Finally, female
pediatricians more frequently endorsed systems barriers with respect to children
and pediatricians working in HMOs or medical school practice settings were
least likely to endorse systems barriers for mothers.
Conclusions: Barriers to pediatric primary care for MH care cluster into physician, patient and systems issues and are distinct for children versus maternal problems. Different characteristics are associated with the 5 barrier clusters, suggesting that interventions to overcome barriers must be multifaceted and tailored.