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

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 a-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.

Specific Components of Pediatricians’ Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement

“…4-6 In the US, pediatricians provide the majority of ADHD medication-related care to pediatric patients. 7,8 Despite multiple efforts to address the quality of ADHD care delivered by pediatricians, 4,9-11 there is much room for improvement in medication-related ADHD care. 1,12,13 …”

Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices

“…2 Currently, a majority of psychotropic medications are prescribed by primary care providers rather than specialists. 3,4 Surveys have found that many pediatricians felt it was their responsibility to identify children with mental health concerns but not to manage these conditions, [5][6][7] with the exception of attention deficit/hyperactivity disorder (ADHD). 5,8 Lack of confidence, 6, 7, 9 knowledge/skills, 7, 9, 10 or time 7, 9, 10 are barriers that limit pediatricians' ability to care for children with mental health issues.…”

Children in the US are at High Risk for Psychiatric Disorders: Early Monitoring by Parents May Enhance Awareness and Treatment

“…They emphasize that toxic stress in childhood (verbal, physical, and sexual abuse or neglect) is a major cause of both medical and psychiatric problems in adulthood. Most children with psychiatric problems are seen by pediatricians and other primary care physicians [23] and having a ready source of parent-generated symptom monitoring will facilitate the process of screening, treatment, or referral.…”