Factors Influencing Pediatric Primary Care Providers' Perceived Capacity to Address Behavioral Health Needs

Area of Science:

• Child and Adolescent Psychiatry
• Primary Care Pediatrics
• Health Services Research

Background:

• Pediatric primary care providers (PPCPs) often face challenges managing behavioral health concerns.
• Child psychiatry access programs (CPAPs) provide essential psychiatric consultation, education, and referral support to primary care settings.

Purpose of the Study:

• To identify factors influencing PPCPs' perceived ability to manage behavioral health issues.
• To assess the impact of these factors on PPCPs' utilization of psychiatric consultation services from a CPAP.

Main Methods:

• Exploratory, sequential mixed-methods study involving focus groups with 52 PPCPs from 11 pediatric practices.
• Analysis of 188 psychiatric consultations (March 2022-April 2024) for purpose, patient demographics, clinical characteristics, and disposition.
• Logistic regression used to examine factors associated with patient disposition (primary care management vs. specialty referral).

Main Results:

• PPCPs reported higher confidence managing common conditions (ADHD, depression, anxiety) but less confidence with complex cases or suicidal ideation.
• Seventy percent of consultations focused on psychotropic medication management.
• 72% of consultations resulted in disposition to primary care management, positively associated with ADHD, depression, or anxiety diagnoses and younger patient age, but negatively associated with clinical risk factors.

Conclusions:

• Psychiatric consultation through CPAPs can potentially improve PPCPs' capacity to manage behavioral health conditions within primary care settings.
• CPAP support may facilitate appropriate disposition and ongoing management of pediatric behavioral health issues in primary care.