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Insurance status and recognition of psychosocial problems. A report from the Pediatric Research in Office Settings
K J Kelleher1, G E Childs, R C Wasserman
1University of Pittsburgh School of Medicine, Pa., USA.
Insights
Clinician recognition of psychosocial problems in children was not linked to insurance type. Instead, provider familiarity and continuity of care were key factors in identifying these issues in pediatric primary care.
Area of Science:
- Pediatric Primary Care
- Health Services Research
- Child Psychology
Background:
- Clinician recognition of psychosocial problems in children is crucial for timely intervention.
- Previous research suggests disparities in treatment based on insurance status.
- The impact of insurance on the initial identification of these issues remains unclear.
Purpose of the Study:
- To investigate the association between insurance status and clinician recognition of psychosocial problems in pediatric primary care settings.
- To identify factors influencing clinician recognition of psychosocial issues in children.
Main Methods:
- A cohort study involving 10,250 pediatric primary care visits for nonemergent care.
- Data collected from 172 clinicians across two primary care research networks.
- Psychosocial problems identified using the Pediatric Symptom Checklist; clinician recognition and insurance status were recorded.
Main Results:
- A significant number of children with psychosocial problems were not recognized by clinicians.
- Insurance type did not correlate with the rates of clinician recognition.
- Provider familiarity, clinician discipline, and patient demographics were associated with higher recognition rates.
Conclusions:
- Observed treatment differences across insurance groups are likely due to treatment availability, not recognition rates.
- Continuity of care emerged as the most significant predictor of clinician recognition of psychosocial problems.
- Future interventions should focus on improving recognition through enhanced provider-patient relationships and continuity.
Objective:
To examine the effect of insurance status on clinician recognition of psychosocial problems for pediatric primary care visits.
Design:
A cohort study of 10,250 visits by children 4 to 15 years old for nonemergent care.
Setting:
Two large primary care research networks reported data from 172 primary care clinicians in office-based practice.
Patients:
Ten thousand two hundred and fifty unique children presenting consecutively to participating physicians for nonemergent services with a parent or caregiver.
Main Outcome Measure:
Children were classified as positive for psychosocial problems if their score on the parent-reported Pediatric Symptom Checklist exceeded the standard cutoff of 28. Clinician recognition was obtained by report as a dichotomous variable. Insurance status was categorized by payor and plan structure.
Results:
Clinicians did not recognize psychosocial problems for a substantial number of children with scores suggestive of marked psychosocial dysfunction on the Pediatric Symptom Checklist. Insurance type was not associated with rates of recognition. However, provider familiarity with patients, provider discipline, and patient demographics were associated with increased recognition of psychosocial problems.
Conclusions:
Differences in treatment among various insurance groups documented in prior studies are not likely to be related to varying recognition rates, but rather to availability and choices of treatment by insurers, families, and clinicians. Continuity of care was the strongest predictor of clinician recognition.