Abstract
Objective
Although it is known that children with mental health problems utilize primary care
services more than most other children, it is unknown how addressing mental health
problems in primary care affects children’s subsequent services utilization. This
study measures primary care utilization in the context of a randomized trial of a
communication skills training program for primary care clinicians that had a positive
impact on child mental health outcomes.
Methods
From 2002 to 2005, 48 pediatric primary care clinicians at 13 sites in rural upstate
New York, urban Maryland, and Washington, DC, were randomized to in-office training
or to a control group. Consecutive primary care patients between the ages of 5 and
16 years were screened for mental health problems, as indicated by a possible or probable
score on the Strengths and Difficulties Questionnaire (SDQ). For 397 screened children,
primary care visits during the next 6 months were identified using chart review and
administrative databases. Using generalized estimating equation regression to account
for clustering at the clinician level, primary care utilization was compared by study
group and SDQ status.
Results
The number of primary care visits to the trained clinicians did not differ significantly
from those made to control clinicians (2.5 for both groups; P = .63). Children with possible or probable SDQ scores made, on average, 0.38 or 0.65
more visits on a per child basis, respectively, during the 6-month follow-up period
than SDQ unlikely children (P = .0002).
Conclusions
Seeing a trained clinician did not increase subsequent primary care utilization. However,
primary care utilization was greater among children with mental health problems as
measured by the SDQ. Addressing children’s mental health in primary care does not
increase the primary care visit burden. Research on overall health services utilization
is needed.
Keywords
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Article info
Publication history
Published online: August 05, 2010
Accepted:
June 22,
2010
Received:
October 29,
2009
Identification
Copyright
© 2010 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
