How common are mental health diagnoses in pediatric primary care? a pilot study using electronic medical records

Background: An evaluation of pediatric practices in the Northeast revealed that there were inconsistencies in the screening and treatment of pediatric mental health problems.

Objective: To study the role of electronic medical records (EMR) in the early identification and treatment of mental health issues among children in a primary care setting.

Methods: Pediatric patient EMR (N=6090) were screened for one year to identify patients with at least one mental health diagnosis. Demographic variables, insurance information, medication(s) and referral status data were extracted for those patients. The frequency and prevalence of mental health rates and co-morbidity rates were calculated and comparative analyses were conducted with a national sample. Demographic strata were examined for differences and referral practices evaluated.

Results: Eighteen percent of patients (N=1087) were identified as having a mental health diagnosis (MHD). The mean age among those with a MHD was 13 years, 60% were male and 99% had insurance (approximately 90% commercial; 10% public). The most prevalent diagnoses were ADHD (40%) and Anxiety (20%). A significant proportion of 5-9 year olds (33%) were dual diagnosed with ADHD and anxiety, and approximately 25% of all patients with anxiety did not receive a referral. The findings were consistent with national data.

Discussion: Primary care doctors are treating a significant number of children with mental health problems starting as young as 5 years. EMR systems demonstrated that they can help pediatric primary care practices monitor the mental health needs of their patient populations and to help ensure effective treatment, referrals and follow-up.