Recognition of anxiety disorders in children: a cross-sectional vignette-based survey among general practitioners
Recognition of anxiety disorders in children: a cross-sectional vignette-based survey among general practitioners
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DOI：
10.1136/bmjopen-2019-035799
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发表时间：
2020-04-01
期刊：
影响因子：
2.9
通讯作者：
Westenberg, P. Michiel
中科院分区：
文献类型：
--
作者：
Aydin, Semiha;Crone, Mathilde R.;Westenberg, P. Michiel
目的量化全科医生（GP）面对儿童焦虑症（AD）常见症状时对AD的敏感性。此外，探索全科医生的有意识的偏好和隐含的倾向，为转介的儿童与广告，以精神healthcare.Design和设置在一个横截面的小插曲为基础的调查，所有与会者的荷兰继续医学教育会议的初级保健医生提出了字幕音频片段的五个小插曲，我们构建了模仿症状的儿童与广告在一般的做法。我们要求与会者在每个小插曲中选择最合理的诊断和最适当的转诊选择，以及当他们怀疑每种最常见的精神健康问题时，他们的一般转诊偏好。结果总共有1128个小片段评价。主要结果测量全科医生在五个小片段中对AD的选择率与精神卫生专业人员提供的基准相比（结果全科医生对AD的识别率低于MHP（OR=0.26，95%CI 0.15 ~ 0.46）。全科医生对焦虑的认识各不相同，44.1%的人没有一次选择焦虑作为可能存在的问题。当被明确询问时，63.9%的全科医生报告说，当他们怀疑可能的广告时，他们会将孩子转介到精神卫生保健。相比之下，只有12.0%的GP谁认识到焦虑的小插曲实际上选择了转介option.Conclusion一个显着的分数的GP没有注意到所描绘的症状焦虑。尽管AD广泛流行，但全科医生在早期诊断意见中似乎已经忽视了焦虑。提高全科医生对初始症状表现、广告的基本率、相关性和影响的熟悉程度，有可能及时识别。
Objective To quantify general practitioners' (GPs) sensitivity to anxiety disorders (ADs) when confronted with the range of symptoms common to children with ADs. Also, to explore GPs' conscious preferences and implicit tendencies for referral of children with ADs to mental healthcare.Design and setting In a cross-sectional vignette-based survey, all attendees of a Dutch continuing medical education conference for primary care physicians were presented with subtitled audio fragments of five vignettes that we constructed to mimic symptom presentation of children with ADs in general practice. We asked attendees to select per vignette the most plausible diagnoses and most adequate referral option, and for their general referral preferences when they suspect each of the most common mental health problems.Participants A sample of 229 GPs, resulting in a total of 1128 vignette evaluations.Main outcome measure GPs' selection rate of ADs in the five vignettes compared with a benchmark provided by mental health professionals (MHPs).Results Overall, recognition of ADs was less likely in GPs compared with MHPs (OR=0.26, 95% CI 0.15 to 0.46). GPs varied in their recognition of anxiety, with 44.1% not once selecting anxiety as the probable presenting problem. When asked explicitly, 63.9% of the GPs reported that they would refer a child to mental healthcare when they suspect probable ADs. By contrast, only 12.0% of the GPs who recognised anxiety in the vignettes actually selected that referral option.Conclusion A significant fraction of GPs did not notice the depicted symptoms as anxiety. Despite the widespread prevalence of ADs, GPs seem to overlook anxiety already in their early diagnostic opinion. Improving GPs' familiarity with initial symptom presentation, ADs' base-rate, relevance and impact yields potential for timely recognition.