Which Pediatricians Co-Manage Mental Health Conditions?

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Objective/Background— Given the prevalence of mental health (MH) conditions (MHCs) in children, pediatricians should initiate treatment alone or in collaboration with a specialist for children with MHCs. However, the majority of pediatricians do not manage or co-manage common MHCs even with an onsite MH provider. This study examines which physician, practice, and training characteristics are associated with pediatricians’ co-managing at least half of their patients with MHCs. Methods— We analyzed responses of general pediatricians (n=305) from the AAP 2013 Periodic Survey. Practice characteristics include presence of an onsite MH provider and perceived access to services. Independent variables included socio-demographics, training experiences, and interest in further training. The outcome was co-management of ≥ 50% of patients with MHCs. Weighted univariate, bivariate and multivariable analyses were performed. Results— Of the pediatricians who reported co-managing ≥50% of their patients with MHCs, logistic regression analysis showed that pediatricians who completed ≥ 4 weeks of DBP training had 1.8 increased odds (1.06, 3.08, p=0.03) of co-management, those very interested in further education in managing/treating MHCs had 2.75 increased odds (1.63, 3.08, p<0.001), and those with more training in MH treatment with medications had 1.4 increased odds (1.12, 1.75, p=0.004) of co-managing children with MHCs. Conclusion— Specific educational experiences and interest in further education in managing/ treating MHCs were significantly associated with co-managing ≥50% of patients suggesting that enhanced MH training among pediatricians could increase the co-management of children with MHCs.

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