Online Program

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

Monday, November 4, 2013

Amy Signore, MPH, Clinical Psychology, University of Rhode Island, Kingston, RI
Louise Kiessling, MD FAAP, Pediatrics and Family Medicine, Alpert Medical School of Brown University
Celeste Corcoran, MD FAAP, Narragansett Bay Pediatrics, Coastal Medical, Wickford, RI
Mark Robbins, Ph.D, Clinical Psychology, University of Rhode Island, Kingston, RI
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.

Learning Areas:

Other professions or practice related to public health
Public health or related nursing
Social and behavioral sciences

Learning Objectives:
Discuss the use of electronic medical records to identify mental health diagnoses and treatment of patients within a pediatric primary care practice. Compare the mental health prevalence in this study to national data. Identify how other pediatric primary care practices could develop similar data.

Keyword(s): Primary Care, Child/Adolescent Mental Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a graduate student in an APA accredited Clinical Psychology PhD program and earned an MPH Degree with a Psychology Focus in 2008. I have worked on several federally-funded projects in Psychology and have authored three peer-reviewed journal articles. I was PI of one project on adolescent mental health. This submission is part of my dissertation project. It is approved by and submitted along with my experienced advisors and co-investigators.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.