ABSTRACT
Presented at the Pediatric Academic Societies annual meeting, May 2005
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.