MANAGEMENT OF PSYCHOSOCIAL PROBLEMS IN PRIMARY CARE

儿童的心理社会问题是常见的和致残的， 对孩子、家庭和社会都是巨大的负担。 大多数 有心理社会问题的儿童在初级保健机构得到管理， 新的医疗服务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）确定类型的 为有心理社会问题的儿童提供的治疗，2）比较 在三种不同的护理系统（管理式护理， 加拿大国家健康保险计划（3） 确定精神卫生服务存在可改变的障碍 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影响提供治疗 特征，以及5）评估了护理中的选定结果， 三个系统使用随机选择的儿童样本， 临床医生确定的心理问题。 该研究将收集 来自父母和临床医生的信息， 4至15岁儿童连续到450个初级保健机构就诊 临床医生 每位临床医生将招募75名符合条件的儿童， 在2至15周期间连续访问。 管理 临床医生在不同的护理系统中使用的策略将是 对所有登记的有心理社会问题的儿童进行检查。 一个900名儿童的样本从那些被确定为 心理社会问题将根据完成的具体措施进行评估 由他们的父母/监护人在六个月，比较结果之间的 护理系统。 参与的临床医生是两个 北美国家基于办公室的初级保健研究网络： 门诊哨兵实践网络（ASPN）和儿科 办公室设置（PROS）网络的研究。 的大量 参与的临床医生，集体研究，以及父母的使用 临床医生报告提供了一个独特的机会， 调查 这项研究将有助于照顾儿童与 通过提高对当前初级保健的认识， 治疗这些儿童的做法，并通过检查的影响， 不同的医疗保健提供系统， 选定的结果。 这些信息将有助于临床医生和 政策制定者评价了行政和财政 在初级保健环境中为儿童提供心理健康服务的障碍。

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.