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Pediatrics. 2015 Nov;136(5):e1178-85. doi: 10.1542/peds.2015-0807. Epub 2015 Oct 12.

Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions.

Author information

1
University of Tennessee College of Medicine, Memphis, Tennessee;
2
Divisions of General Pediatrics, Center for Child and Adolescent Health Research and Policy, and.
3
General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts; and Department of Pediatrics, Harvard Medical School, Pediatrics, Boston, Massachusetts.
4
General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts; and Department of Pediatrics, Harvard Medical School, Pediatrics, Boston, Massachusetts jvancleave@partners.org.

Abstract

OBJECTIVE:

To compare the mental health care US children receive from primary care providers (PCPs) and other mental health care providers.

METHODS:

Using nationally representative data from the Medical Expenditure Panel Survey (MEPS) from 2008 to 2011, we determined whether children and youth aged 2 to 21 years with outpatient visits for mental health problems in the past year saw PCPs, psychiatrists, and/or psychologists/social workers for these conditions. We compared the proportion of children prescribed psychotropic medications by provider type. Using logistic regression, we examined associations of provider type seen and medication prescribing with race/ethnicity, household income, insurance status, geographical area, and language at home.

RESULTS:

One-third (34.8%) of children receiving outpatient care for mental health conditions saw PCPs only, 26.2% saw psychiatrists only, and 15.2% saw psychologists/social workers only. Nearly a quarter (23.8%) of children saw multiple providers. A greater proportion of children with attention-deficit/hyperactivity disorder (ADHD) versus children with anxiety/mood disorders saw a PCP only (41.8% vs 17.2%). PCPs prescribed medications to a higher percentage of children than did psychiatrists. Children seeing a PCP for ADHD were more likely to receive stimulants or α-agonists than children with ADHD seeing psychiatrists (73.7% vs 61.4%). We found only limited associations of sociodemographic characteristics with provider type or medication use.

CONCLUSIONS:

PCPs appear to be sole physician managers for care of 4 in 10 US children with ADHD, and one-third with mental health conditions overall. Efforts supporting mental health in primary care will reach a substantial portion of children receiving mental health services.

PMID:
26459647
PMCID:
PMC4621795
DOI:
10.1542/peds.2015-0807
[Indexed for MEDLINE]
Free PMC Article

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