Running out of time: Physician management of behavioral health concerns in rural pediatric primary care
Running out of time: Physician management of behavioral health concerns in rural pediatric primary care
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DOI：
10.1542/peds.2005-2612
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发表时间：
2006-07-01
期刊：
影响因子：
8
通讯作者：
Evans, Joseph H.
中科院分区：
文献类型：
--
作者：
Cooper, Stephanie;Valleley, Rachel J.;Evans, Joseph H.
客观的。这项工作的目的是检查儿科医生对农村初级保健就诊中提出的行为健康问题的反应，特别关注所花费的时间。方法。研究助理直接观察了 2 个农村儿科初级保健办公室的 302 名患者就诊情况。记录就诊时间、提出的问题以及医生的反应。评估者间的可靠性（25% 的观察访问得分）很高。 结果。在观察到的所有初级保健就诊中，23.6% 的人提出了行为、情感或发育问题。大约 9% 的访视在访视前被确定为心理咨询，并且比其他原因的访视持续时间大约长 7 分钟。在最初未被确定为心理咨询的就诊中，约 18% 的人提出了行为问题。在这些情况下，访问时长平均增加超过 5 分钟，具有统计学上的显着差异。此外，在这些访问期间，对行为问题的讨论往往占用了一半以上的访问时间。数据表明，医生对行为、发育或情感问题做出了反应，在提出此类问题时参与了进一步的评估、支持性陈述、治疗或转诊，类似于 97% 的就诊。结论。研究结果与之前的研究一致，表明大约四分之一的初级保健就诊涉及行为、发育或情感问题的讨论。此外，这项研究首次记录了此类担忧对儿科医生时间的具体影响，这通常被认为是他们难以有效识别和治疗初级保健中出现的行为问题的关键原因。这些数据为对照研究提供了起点，包括农村与城市样本的比较以及各种协作护理模式的影响。
OBJECTIVE. The purpose of this work was to examine pediatricians' responses to behavioral health concerns raised in the context of rural primary care visits with particular focus on time spent.METHODS. Research assistants directly observed 302 patient visits in 2 rural pediatric primary care offices. The length of the visit, concerns raised, and physicians' responses were recorded. Interrater reliability, scored for 25% of observed visits, was strong.RESULTS. Behavioral, emotional, or developmental concerns were raised by either the parent or physician in 23.6% of all primary care visits observed. Approximately 9% of all visits were identified as a psychological consultation before the visit and lasted similar to 7 minutes longer than visits for other reasons. Behavioral concerns were raised during similar to 18% of visits not originally identified as a psychological consultation. In these cases, visit length increased by > 5 minutes on average, a statistically significant difference. In addition, during these visits, discussion of behavioral concerns often consumed more than half of the visit. Data suggested that physicians were responsive to behavioral, developmental, or emotional concerns, engaging in further assessment, supportive statements, treatment, or referral in similar to 97% of the visits when such concerns were raised.CONCLUSIONS. Findings converge with previous research, showing that approximately one quarter of all primary care visits involve a discussion of behavioral, developmental, or emotional concerns. Moreover, this study is the first to document the specific impact of such concerns on pediatricians' time, often sited as a key reason why they struggle to effectively identify and treat behavioral concerns presenting in primary care. These data provide a starting point for controlled studies, including comparisons of rural versus urban samples and the impact of various collaborative models of care.