Assessing the quality of care for paediatric depression and anxiety in Australia: A population-based sample survey
Louise A Ellis1, Louise K Wiles1,2, Ruth Selig3
1Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
Insights
Quality of care for Australian children with depression and anxiety is low, with poor adherence to clinical guidelines. Improvements are needed, especially for general practitioners, to enhance mental health support for young patients.
Area of Science:
- Pediatric Mental Health
- Healthcare Quality Improvement
- Clinical Practice Guidelines
Background:
- Quality of care for pediatric mental health conditions is crucial for long-term outcomes.
- Adherence to clinical practice guidelines (CPGs) is a key measure of healthcare quality.
- Previous studies have highlighted variability in care for children with mental health disorders.
Purpose of the Study:
- To examine the adherence to CPGs for Australian pediatric patients (<=15 years) with depression and/or anxiety.
- To identify areas of high and low adherence to assessment and management guidelines.
- To inform strategies for improving mental healthcare quality in children and adolescents.
Main Methods:
- Utilized data from the population-based CareTrack Kids study.
- Included a multistage stratified sample of 6689 children's records.
- Assessed adherence to 15 depression and 13 anxiety indicators via medical record review for 156 (depression) and 356 (anxiety) identified cases.
Main Results:
- Low adherence to assessment and management bundles for both depression (33% and 35%) and anxiety (54% and not specified).
- Highest adherence observed for medication prescriptions (e.g., SSRIs, antidepressants).
- Lowest adherence for critical safety measures: emergency safety plans for depression (44%), informing parents about medication risks (51%), and assessing for other causes (59-68%).
Conclusions:
- Significant gaps exist in guideline adherence for pediatric mental health conditions in Australia.
- Strategies are needed to improve care, particularly for general practitioners.
- Clinical decision support tools, such as electronic medical record prompts, could enhance guideline compliance.
Objective:
We examine the prevalence of quality care (as measured by adherence to recommendations in clinical practice guidelines) for Australian paediatric patients (⩽15 years) with depression and/or anxiety, using data from the CareTrack Kids study; a population-based study of the quality of healthcare practice in inpatient and ambulatory healthcare settings.
Methods:
A multistage stratified sample identified records of 6689 children. Of these, 156 records were identified for depression and 356 for anxiety. These were assessed for adherence to 15 depression and 13 anxiety indicators, respectively, using a review of medical records.
Results:
Adherence to assessment and management guidelines was low for both conditions: assessment bundle (depression = 33%, 95% confidence interval = [20, 48]; anxiety = 54%, 95% confidence interval = [43, 64] and depression management bundle = 35%, 95% confidence interval = [15, 60]). Across both conditions, the highest adherence was recorded for indicators that addressed prescription of medications (e.g. venlafaxine, 100%; benzodiazepines, 100%; selective serotonin reuptake inhibitor, 94% and antidepressants, 91%), while compliance was the lowest for ensuring children with depression had an emergency safety plan (44%), informing parents of the risks and benefits of prescribed anxiety medication (51%) and assessment for other causes (59% for depression; 68% for anxiety).
Conclusion:
These findings suggest that strategies are needed to improve guideline adherence for mental health disorders in children and adolescents, particularly among general practitioners. Learning from these indicators could inform clinical prompts in electronic medical records, as well as links to additional information, to assist in decision-making and streamline work practices.
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