MANAGEMENT OF PSYCHOSOCIAL PROBLEMS IN PRIMARY CARE

初级保健中心理社会问题的管理

• 批准号: 2249982
• 负责人: Kelly J Kelleher
• 金额: $ 75.51万
• 依托单位: AMBULATORY SENTINEL PRACTICE NETWORK
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-06-01 至 1997-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2249982
• 关键词: adolescence (12-20); child behavior; child behavior disorders; child health care personnel; child mental disorders; child mental health service; family structure /dynamics; functional ability; general practitioners; health care referral /consultation; health care service evaluation; health care service organization; health care service utilization; health insurance; human subject; managed care; mental health counseling; middle childhood (6-11); patient care management; patient care personnel attitude; pharmacy administration; primary care physician; questionnaires; therapy compliance

Psychosocial problems in children are common and disabling, resulting in a tremendous burden to children, families, ad society. The majority of children with psychosocial problems are managed in primary care settings, where new health care delivery systems are increasingly affecting management decisions by clinicians. Using a large sample of office-based primary care clinicians, this study will: 1) identify the types of treatment offered to children with psychosocial problems, 2) compare treatment choices among three different systems of care (managed care, fee-for-service, and Canadian national Health Insurance Plan), 3) determine the presence of modifiable barriers to mental health services across the systems of care, 4) distinguish the effect of these barriers on treatment provided from the effect of clinician and patient characteristics, and 5) evaluated selected outcomes of care among the three systems using a randomly selected sample of children with clinician-identified psychosocial problems. The study will collect information from parents and clinicians about more than 30,000 consecutive office visits by children 4 to 15 years to 450 primary care clinicians. Each clinician will enroll 75 eligible children seen for consecutive visits during a period of 2 to 15 weeks. The management strategies used by the clinicians in different systems of care will be examined for all enrolled children with identified psychosocial problems. A sample of 900 children randomly selected from those with identified psychosocial problems will be evaluated on specific measures completed by their parents/guardians at six months to compare outcomes among the systems of care. Participating clinicians are members of the two national office-based, primary care research networks in North America: the Ambulatory Sentinel Practice Network (ASPN) and the Pediatric Research in Office Settings (PROS) network. The large number of participating clinicians, the collective research, and the use of parent and clinician reports provide a unique opportunity to conduct this investigation. The research will contribute to the care of children with psychosocial problems by increasing knowledge of current primary care treatment practices for these children, and by examining the impact of different health care delivery systems on the receipt of treatment and selected outcomes. This information will be useful as clinicians and policy-markers evaluated the impact of administrative and financial barriers on mental health services for children in primary care settings.

儿童的心理社会问题是常见的和致残的，导致 这给儿童、家庭和社会带来了巨大的负担。大多数人 有心理社会问题的儿童在初级保健环境中得到管理， 新的医疗保健提供系统越来越多地影响到 临床医生的管理决策。使用基于办公室的大样本 初级保健临床医生，这项研究将：1)确定 为有心理社会问题的儿童提供的治疗，2)比较 在三种不同的医疗系统中选择治疗(管理式医疗、 服务费和加拿大国家医疗保险计划)，3) 确定心理健康服务是否存在可修改的障碍 在整个护理系统中，4)区分这些障碍的影响 从临床医生和患者的作用谈医疗服务 特征，以及5)评估在以下人群中选择的护理结果 使用随机选择的儿童样本的三个系统 临床医生发现的心理社会问题。这项研究将收集 来自父母和临床医生的关于30,000多人的信息 4至15岁儿童连续就诊450次初级保健 临床医生。每位临床医生将招募75名符合条件的儿童参加 在2至15周内连续探视。管理层 临床医生在不同的护理系统中使用的策略将是 对所有已确定有心理社会问题的入学儿童进行检查。 从确诊的儿童中随机挑选900名儿童的样本 将根据已完成的具体措施来评估心理社会问题 由他们的父母/监护人在六个月大时比较 护理系统。参与的临床医生是这两个组织的成员 北美以国家办公室为基础的初级保健研究网络： 动态哨兵实践网络(ASPN)与儿科 研究办公设置(PROS)网络。数量庞大的 参与临床医生、集体研究和父母的使用 而临床医生的报告提供了一个独特的机会来进行这一点 调查。这项研究将有助于照顾患有癌症的儿童 通过增加对当前初级保健的了解来解决心理社会问题 针对这些儿童的治疗实践，并通过检查 不同的医疗保健提供制度在接受治疗和 选定的结果。这些信息将对临床医生和 政策标记者评估了行政和财务的影响 初级保健环境中儿童心理健康服务方面的障碍。