查看文章

Background

Early childhood mental health (ECMH) integration into primary care is associated with improved patient outcomes, a connection of families to resources, improved patient-provider relationships, and reduction in emergency department utilization. This study investigated practice-level factors that are associated with higher levels of ECMH integration into pediatric primary care.

Methods

Data came from a statewide survey of 100 pediatric primary care practices across the state of Massachusetts. The survey used the 15-item Substance Abuse and Mental Health Services Administration Integrated Practice Assessment Tool to measure the level of mental health integration into primary care. The survey also included questions on practice-level demographics. Analyses used multivariate logistic regression with multiple imputation to identify practice characteristics that predicted a high level of integration.

Results

Practices reported either serving urban communities (60%) or serving rural and suburban communities (40%); 30% reported seeing mainly patients covered through public health insurance. At 32% of practices, the patients were mainly non-Hispanic White race/ethnicity and at 35% of practices, patients were a heterogenous race/ethnicity mix. Results demonstrated a statistically significant relationship between urbanicity and ECMH integration, controlling for other practice characteristics. Practices that served rural and suburban areas had a 42% reduced likelihood of being highly integrated compared to practices that exclusively served urban areas or multiple areas (AOR= 0.58, 95% CI 0.34, 0.98, p= 0.0422). Moreover, practices that …