Severity of mental health concerns in pediatric primary care and the role of child psychiatry access programs
| Autor: | Sean Pustilnik, Nicole Gloff, Rheanna Platt, Kelly Bower, Elizabeth H. Connors |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Adolescent macromolecular substances Telehealth Primary care Physicians Primary Care Odds 03 medical and health sciences 0302 clinical medicine 030225 pediatrics medicine Child and adolescent psychiatry Humans Clinical severity Medical prescription Child Child Psychiatry Maryland Primary Health Care business.industry Mental Disorders Infant Mental health 030227 psychiatry Psychiatry and Mental health Child Preschool Family medicine Female business |
| Zdroj: | General Hospital Psychiatry. 53:12-18 |
| ISSN: | 0163-8343 |
| Popis: | Objective To describe the clinical severity of patients for whom Primary Care Providers (PCPs) requested consultation from Maryland's Child Psychiatry Access Program (CPAP), and examine the proportion and associated characteristics of severe cases being managed alone by PCPs versus co-managed with mental health specialists. Methods Data were collected for 872 cases based on calls received between October 2012 and December 2016. Severity was measured by consultant-assigned Clinical Global Impression-Severity (CGI-S) score. The unadjusted odds of a PCP managing a case alone for select patient and provider characteristics was calculated in a sub-sample of 229 severe cases. Results 73.8% of cases were categorized as mild-moderate (CGI-S 1–4) and 26.3% as severe (CGI-S 5–7). 67.3% of severe cases were managed by a PCP alone; 32.8% were co-managed. The unadjusted odds of a severe case managed alone was lower for cases with greater numbers of psychotropic medications (OR 0.76, 95% CI 0.6, 0.96), prescription of antidepressants (OR 0.51, 95% CI 0.28, 0.95), or antipsychotics (OR 0.45, 95% CI 0.22, 0.94) compared to co-managed cases. Conclusions PCPs manage patients with severe mental health concerns, often without assistance from specialists. CPAPs should systematically consider how to support the PCPs' role managing clinically severe cases. |
| Databáze: | OpenAIRE |
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