Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices
Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices
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DOI：
10.1542/peds.2015-2974
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发表时间：
2016-05-01
期刊：
影响因子：
8
通讯作者：
Fiks, Alexander G.
中科院分区：
文献类型：
--
作者：
Mayne, Stephanie L.;Ross, Michelle E.;Fiks, Alexander G.
背景技术背景：初级保健儿科医生越来越关心儿童的心理健康问题，但鲜为人知的是实践水平的变化，在诊断和精神药物处方practice.METHODS：这一回顾性审查的电子健康记录从43个美国初级保健的做法，包括4至18岁的儿童，从2009年1月1日至2014年6月30日，>= 1办公室访问。我们使用具有实践固定效应的逻辑回归来检查实践中诊断和精神药物处方的变异性，并使用广义线性混合模型来评估托管或基于社区的精神卫生服务提供者的可用性或寄养儿童的比例与诊断和处方的关联。在294 748名儿童中，40 932名（15%）接受了精神健康诊断，39 695名（14%）接受了精神药物治疗。注意力缺陷/多动障碍是最常见的诊断（1%-16%的实践）。接受任何精神药物治疗的儿童比例（4%-26%）和接受≥ 2类药物治疗的儿童比例（1%-12%）因实践而异。具体药物类别的处方也各不相同（兴奋剂，3%-18%;抗抑郁药，1%-12%; α-激动剂，0%-8%;第二代抗精神病药，0%-5%）。变异性部分解释了社区精神科医生（诊断或处方时不可用的几率显着较高）的可用性，但不是由托管的精神卫生专业人员或寄养儿童的百分比。结论：精神卫生诊断和精神药物处方的患病率有很大不同的做法，只有部分解释了精神科医生的可用性。需要进行研究，以更好地确定可变的实践水平的诊断和处方的原因和对儿童心理健康结果的影响。
BACKGROUND: Primary care pediatricians increasingly care for children's mental health problems, but little is known about practice-level variation in diagnosis and psychotropic medication prescribing practices.METHODS: This retrospective review of electronic heath records from 43 US primary care practices included children aged 4 to 18 years with >= 1 office visit from January 1, 2009, to June 30, 2014. We examined variability in diagnosis and psychotropic prescribing across practices using logistic regression with practice fixed effects and evaluated associations of the availability of colocated or community-based mental health providers or the proportion of children in foster care with diagnosis and prescribing using generalized linear mixed models.RESULTS: Among 294 748 children, 40 932 (15%) received a mental health diagnosis and 39 695 (14%) were prescribed psychotropic medication. Attention deficit/hyperactivity disorder was most commonly diagnosed (1%-16% per practice). The proportion of children receiving any psychotropic medication (4%-26%) and the proportion receiving >= 2 medication classes (1%-12%) varied across practices. Prescribing of specific medication classes also varied (stimulants, 3%-18%; antidepressants, 1%-12%; alpha-agonists, 0%-8%; second-generation antipsychotics, 0%-5%). Variability was partially explained by community availability of psychiatrists (significantly higher odds of a diagnosis or prescription when not available) but not by colocation of mental health professionals or percentage of children in foster care.CONCLUSIONS: The prevalence of mental health diagnosis and psychotropic medication prescribing varies substantially across practices and is only partially explained by psychiatrist availability. Research is needed to better define the causes of variable practice-level diagnosis and prescribing and implications for child mental health outcomes.