Transparent criteria for specialist level adolescent psychiatric care.
BACKGROUND
Rising health care costs and long waiting lists pose a challenge to public specialist level health services. In Finland, the Ministry of Social Affairs and Health required all medical specialities to create a priority-rating tool for elective patients, preferably giving a numerical rating ranging 0-100, with 50 as an entry threshold.


OBJECTIVE
To create and test the psychometric properties of a point-count measure for prioritising entry to public specialist level adolescent psychiatric services.


METHODS
Around 710 referred adolescents were given ratings on 17 items focusing on symptom severity, problem behaviours, functioning, progress of adolescent development and prognosis. The structured ratings were compared to an overall assessment of need for treatment on a VAS scale. In order to ensure that the tool was not inappropriately sensitive to confounding by non-disturbance related factors, the associations between the structured priority rating and sex, age, referring agent, study site and diagnosis were analysed.


RESULTS
Of the 17 items, 15 were included in the final priority-rating tool. The requirement than threshold score for entry to services being set at 50 points necessitated scoring factors rather than individual items. Four blocks of items were formed: symptoms and risks; impaired functioning; other relevant issues, and prognosis without specialist level treatment. Most of the referred adolescents scored over the threshold of 50. When diagnosis was controlled for, scoring over 50 was largely independent of age, sex, referring agent or study site.


CONCLUSIONS
The structured priority ratings corresponded well with clinical global rating of need for care. The tool was not inappropriately sensitive to age, sex, referring agent or study site. In the future, follow-up studies will be needed to evaluate the predictive value of priority ratings.
Kaltiala-Heino
Riittakerttu
R
Department of Adolescent Psychiatry, Tampere University Hospital, and Tampere School of Public Health, Tampere, Finland. riittakerttu.kaltiala-heino@pshp.fi
Fröjd
Sari
S
Autio
Ville
V
Laukkanen
Eila
E
Närhi
Pekka
P
Rantanen
Päivi
P
D000293:Adolescent; D000296:Adolescent Psychiatry / Q000379:methods*; D000328:Adult; D002648:Child; D005260:Female; D005387:Finland; D019538:Health Care Surveys; D006291:Health Policy; D006292:Health Priorities; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D009313:National Health Programs / Q000458:organization & administration; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D012017:Referral and Consultation; D012720:Severity of Illness Index