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Interventions for pediatricians *only partially* successful
Interventions for pediatricians only partially successful
Continuing medical education, newsletters and resource guides were only
partially successful in changing the way that pediatricians handled
behavioral health problems, according to a follow-up study at Wake Forest
University School of Medicine.
But external factors, especially "black box warnings" from the U.S. Food and
Drug Administration "exerted a powerful effect on prescribing practices,"
said Jane Williams, Ph.D., and colleagues, writing in the June issue of
Clinical Pediatrics . So did the changes in the public mental health system
brought about by North Carolina's mental health reform.
In 2004, the same group reported in Pediatrics that pediatricians were
diagnosing and treating growing numbers of children with behavioral health
problems - about 15 percent of the children they see - but did not always
feel sufficiently trained to fill this new role.
This year, Williams and her colleagues went back to 42 primary care
pediatricians they had originally interviewed in 2002-03 to find out which
of a series of what they called "structured interventions" worked.
The structured interventions "focused on recognition, treatment and referral
of children with behavioral health problems," Williams said. They included a
quarterly newsletter, Pediatric Mental Health Connections, a Mental Health
Resource Guide consisting of information about community mental health
providers, quarterly collaborative behavioral health "rounds," and three
continuing education workshops covering screening children for developmental
and behavioral problems and diagnosing and treating depression.
Williams noted that the structured interventions "focused on increased
education in areas requested by the pediatricians, especially recognition of
anxiety and depression, increased awareness of community mental health
providers, increased communication between pediatricians and mental health
providers, and use of a community protocol for attention deficit
hyperactivity disorder (ADHD)."
She said the interventions were associated with:
A significant increase in the use of community social workers for mental
Collaboration with mental health providers concerning patient care.
Use of a common measure for the diagnosis of ADHD.
ADHD remained the behavioral problem most often diagnosed by the
pediatricians, who continued to have a high degree of confidence in treating
ADHD with stimulants.
The level of pediatricians who said they used a class of drugs called SSRIs
(selective serotonin reuptake inhibitors) "frequently or occasionally"
plummeted from 52 percent to 26 percent after the FDA warning that use of
the drugs might increase suicidal behavior.
In the interviews, 88 percent of the pediatricians said they read the
Pediatric Mental Health Connections, 79 percent used the resource guide, 31
percent participated in the interdisciplinary sessions, 21 percent attended
a workshop, and 60 percent said they pursued increased mental health
Most important, "Eighty-three percent indicated they consulted with a mental
health colleague concerning pediatric patients with mental health problems,"
Williams and her colleagues noted that identification and treatment of
mental health disorders in primary care is evolving. She said systemic
changes including use of financial incentives to motivate primary care
pediatricians to identify, treat and refer behavioral patients, increased
access to mental health providers for consultations, practice guidelines and
use of technology for continuing education may change practice patterns.
The Wake Forest research team included Kurt Klinepeter, M.D., Guy Palmes,
M.D., Anita Pulley, M.S.N., R.N., and Jane Meschan Foy, M.D.
Wake Forest University Baptist Medical Center is an academic health system
comprised of North Carolina Baptist Hospital and Wake Forest University
Health Sciences, which operates the university's School of Medicine. U.S.
News & World Report ranks Wake Forest University School of Medicine 18th in
primary care and 44th in research among the nation's medical schools. It
ranks 35th in research funding by the National Institutes of Health. Almost
150 members of the medical school faculty are listed in Best Doctors in
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