Title
Work experience and style explain variation among pediatricians in the detection of children with psychosocial problems
Author
Theunissen, M.H.C.
Vogels, A.G.C.
Reijneveld, S.A.
Publication year
2012
Abstract
OBJECTIVE: To assess whether variation in the proportion of children identified as having psychosocial problems by individual preventive pediatricians can be explained by pediatrician characteristics, over and above variations in the mix of children. Furthermore, to assess whether the characteristics of preventive pediatricians were related to the quality of problem identification. METHODS: We used data from approximately 3070 children ages 5 to 6 years who were assessed during a routine well-child visit by a preventive pediatrician in the Netherlands (response rate 85.2%). We obtained data about parent-reported child problems by using the Child Behavior Checklist (CBCL), sociodemographic background of the family, and characteristics of the preventive pediatrician. After each assessment, preventive pediatricians reported whether they had identified any psychosocial problem in the child. Multilevel logistic regression analyses were used to assess whether variation in the proportion of children identified by preventive pediatricians as having a psychosocial problem could be explained by the characteristics of preventive pediatricians and whether these characteristics were related to the quality of problem identification. RESULTS: Preventive pediatricians varied widely in the proportion of children identified as having psychosocial problems. Pediatrician characteristics such as work experience and work style (for example, on indication use of behavior questionnaires like the CBCL in routine care) explained about a quarter of this inter-pediatrician variation; child characteristics did not explain this variation even though characteristics like gender and parental education level were associated with likelihood of problem identification. More use of the CBCL and less use of the Teacher Report Form in routine care resulted in a better problem identification by preventive pediatricians. Work experience was not related to better problem identification. CONCLUSIONS: Preventive pediatricians identify psychosocial problems in children in a standardized way, but important inter-pediatrician variation remains. This variation may be reduced further and quality improved by changing their work style and targeted training.
Subject
Human
CH - Child Health
BSS - Behavioural and Societal Sciences
Healthy for Life
Health
Healthy Living
child mental health
physician descision
public health
To reference this document use:
http://resolver.tudelft.nl/uuid:a5408a52-106f-4f92-b890-03c66f8506d3
DOI
https://doi.org/10.1016/j.acap.2012.07.004
TNO identifier
465871
Source
Academic Pediatrics, 12 (6), 495-501
Document type
article