Primary care pediatricians' roles and perceived responsibilities in the identification and management of depression in children and adolescents.
Primary care pediatricians' roles and perceived responsibilities in the identification and management of depression in children and adolescents.
复制标题
初级保健儿科医生在儿童和青少年抑郁症的识别和管理中的作用和感知的责任。
DOI：
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复制
发表时间：
2001
期刊：
影响因子：
--
通讯作者：
A. Dietrich
中科院分区：
文献类型：
--
作者：
A. Olson;K. Kelleher;K. Kemper;B. Zuckerman;C. Hammond;A. Dietrich
客观化
描述初级保健儿科医生1)识别和管理儿童和青少年抑郁症的方法，以及2)他们在认识和管理儿童和青少年抑郁症方面的技能、责任和障碍。
设计与方法
对随机选择的初级保健儿科医生进行的全国横断面调查，评估了对被召回的最后一例儿童或青少年抑郁症的管理、态度、对护理的障碍和技能的限制，以及实施新的教育或干预战略以改善护理的意愿。
结果
完成了280份关于儿童和青少年抑郁的调查(回应率为63%)。绝大多数儿科医生报告说，他们有责任认识到儿童和青少年的抑郁症(90%)，但不太可能觉得有责任治疗儿童或青少年(26%-27%)。那些在大写的管理式护理中实践最多的人，无论是在儿童还是青少年中，都不太可能感到有责任认识到抑郁症。46%的儿科医生对自己识别儿童抑郁症的技能缺乏信心，他们中几乎没有人(10%-14%)对自己在儿童或青少年治疗的不同方面的技能有信心。248名儿科医生提供了他们最近回忆的儿童或青少年抑郁症病例的诊断、评估和治疗细节。除了将78%-79%的病例转介给精神卫生保健专业人员外，77%的儿科医生还提供了广泛的简短干预。只有19%-20%的人开了药。限制他们诊断或处理的主要因素是时间(56%-68%)和培训或问题知识(38%-56%)。较少的儿科医生注意到由于保险公司或财务问题(8%-39%)或患者问题(19%-31%)而受到限制。35%的儿科医生有动机改变他们对疑似抑郁症的认识和管理，他们对未来实施各种新策略以改善护理的兴趣明显更大。
结论
初级保健儿科医生认为有责任识别而不是治疗儿童和青少年抑郁症。虽然缺乏信心、缺乏知识和/或技能以及时间问题是限制儿科医生治疗儿童和青少年抑郁症的主要障碍，但儿科医生在准备改变方面各有不同，有些医生更愿意实施新的战略来照顾抑郁症。教育和实践干预需要侧重于如何帮助所有儿科医生进行诊断，并使这些积极的儿科医生准备好在初级保健环境中管理抑郁症。
OBJECTIVE
To describe primary care pediatricians' 1) approach to the identification and management of childhood and adolescent depression and 2) perception of their skills, responsibilities, and barriers in recognizing and managing depression in children and adolescents.
DESIGN AND METHODS
National cross-sectional survey of randomly selected primary care pediatricians that assessed the management of recalled last case of child or adolescent depression, attitudes, limitations to care from barriers and skills, and willingness to implement new educational or intervention strategies to improve care.
RESULTS
There were 280 completed surveys about child and adolescent depression (63% response rate). Pediatricians overwhelmingly reported it was their responsibility to recognize depression in both children and adolescents (90%) but were unlikely to feel responsible for treating children or adolescents (26%-27%). Those with most of their practice in capitated managed care were less likely to feel responsible for recognizing depression in either children or adolescents. Forty-six percent of pediatricians lacked confidence in their skills to recognize depression in children, and few of them (10%-14%) had confidence in their skills in different aspects of treatment with children or adolescents. Diagnostic, assessment, and management details for their last recalled case of depression in a child or adolescent were provided by 248 of these pediatricians. In addition to referring 78%-79% of the cases to mental health care professionals, 77% of pediatricians provided a wide range of brief interventions. Only 19%-20% prescribed medication. Major factors cited that limited their diagnosis or management were time (56%-68%) and training or knowledge of issues (38%-56%). Fewer pediatricians noted limitations due to insurer or financial issues (8%-39%) or patient issues (19%-31%). The 35% of pediatricians who were motivated to change their recognition and management of suspected depression were significantly more interested in implementing in the future a variety of new strategies to improve care.
CONCLUSION
Primary care pediatricians felt responsible for recognizing but not for treating child and adolescent depression. Although the lack of confidence and lack of knowledge and/or skills and time issues are major barriers that limit pediatricians in their treatment of childhood and adolescent depression, pediatricians varied in their readiness to change, with some being more willing to implement new strategies to care for depression. Educational and practice interventions need to focus on how to assist all pediatricians in diagnosis and to prepare these motivated pediatricians to manage depression in primary care settings.
儿科初级保健中的精神病理学：新的隐藏发病率。
影响因子：
8
作者：
Costello,EJ;Edelbrock,C;Costello,AJ;Dulcan,MK;Burns,BJ;Brent,D
通讯作者：
Brent,D
检测接受预付费或按服务收费护理的患者的抑郁症。
DOI：
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发表时间：
1989
期刊：
JAMA : the journal of the American Medical Association
影响因子：
--
作者：
Wells,KB;Hays,RD;Burnam,MA;Rogers,W;Greenfield,S;WareJr,JE
通讯作者：
WareJr,JE