Work experience and style explain variation among pediatricians in the detection of children with psychosocial
Meinou H C Theunissen1, Antonius G C Vogels, Sijmen A Reijneveld
1TNO Child Health, Leiden, The Netherlands. Meinou.Theunissen@tno.nl
Insights
Pediatrician work style, not child background, influences psychosocial problem identification. Improving pediatrician training and approach can enhance the quality of identifying child mental health issues.
Area of Science:
- Pediatrics
- Child Psychology
- Healthcare Quality Improvement
Background:
- Identifying psychosocial problems in children is crucial for early intervention.
- Variation exists in how pediatricians identify these issues, impacting care consistency.
Purpose of the Study:
- To determine if pediatrician characteristics explain variations in identifying children's psychosocial problems.
- To assess if pediatrician traits correlate with the quality of problem identification.
Main Methods:
- Utilized data from 3070 children (ages 5-6) assessed by Dutch preventive pediatricians.
- Employed the Child Behavior Checklist (CBCL) for parent-reported problems and collected pediatrician characteristics.
- Applied multilevel logistic regression to analyze variations and quality of problem identification.
Main Results:
- Significant variation was observed in the proportion of children identified with psychosocial problems among pediatricians.
- Pediatrician characteristics, like work style (e.g., using CBCL), explained 25% of this variation, while child characteristics did not.
- Increased use of the CBCL and decreased use of the Teacher Report Form improved problem identification quality.
Conclusions:
- While a standardized approach exists, substantial inter-pediatrician variation in identifying psychosocial problems persists.
- Modifying pediatrician work styles and implementing targeted training can further reduce variation and enhance identification quality.
Objective:
To assess whether variation in the proportion of children identified as having psychosocial problems by individual preventive pediatricians can be explained by pediatrician characteristics, over and above variations in the mix of children. Furthermore, to assess whether the characteristics of preventive pediatricians were related to the quality of problem identification.
Methods:
We used data from approximately 3070 children ages 5 to 6 years who were assessed during a routine well-child visit by a preventive pediatrician in the Netherlands (response rate 85.2%). We obtained data about parent-reported child problems by using the Child Behavior Checklist (CBCL), sociodemographic background of the family, and characteristics of the preventive pediatrician. After each assessment, preventive pediatricians reported whether they had identified any psychosocial problem in the child. Multilevel logistic regression analyses were used to assess whether variation in the proportion of children identified by preventive pediatricians as having a psychosocial problem could be explained by the characteristics of preventive pediatricians and whether these characteristics were related to the quality of problem identification.
Results:
Preventive pediatricians varied widely in the proportion of children identified as having psychosocial problems. Pediatrician characteristics such as work experience and work style (for example, on indication use of behavior questionnaires like the CBCL in routine care) explained about a quarter of this inter-pediatrician variation; child characteristics did not explain this variation even though characteristics like gender and parental education level were associated with likelihood of problem identification. More use of the CBCL and less use of the Teacher Report Form in routine care resulted in a better problem identification by preventive pediatricians. Work experience was not related to better problem identification.
Conclusions:
Preventive pediatricians identify psychosocial problems in children in a standardized way, but important inter-pediatrician variation remains. This variation may be reduced further and quality improved by changing their work style and targeted training.
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