Insurance status and recognition of psychosocial problems. A report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Networks.
OBJECTIVE
To examine the effect of insurance status on clinician recognition of psychosocial problems for pediatric primary care visits.


METHODS
A cohort study of 10,250 visits by children 4 to 15 years old for nonemergent care.


METHODS
Two large primary care research networks reported data from 172 primary care clinicians in office-based practice.


METHODS
Ten thousand two hundred and fifty unique children presenting consecutively to participating physicians for nonemergent services with a parent or caregiver.


METHODS
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.
Kelleher
K J
KJ
University of Pittsburgh School of Medicine, Pa., USA.
Childs
G E
GE
Wasserman
R C
RC
McInerny
T K
TK
Nutting
P A
PA
Gardner
W P
WP
D015331:Cohort Studies; D003266:Continuity of Patient Care; D003937:Diagnosis, Differential; D005194:Family Practice; D018588:Fee-for-Service Plans; D006801:Humans; D007348:Insurance, Health; D008329:Managed Care Programs; D019964:Mood Disorders / Q000175:diagnosis*; D010372:Pediatrics; D012944:Social Support