Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study
Abstract Background In Germany, 19.1% of boys and 14.5% of girls are affected by mental health problems (MHP). Paediatricians are usually the first in line to be contacted but they often do not feel adequately trained to diagnose and treat MHP in primary care. A major statutory health insurance fund...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | BMC Primary Care |
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| Online Access: | https://doi.org/10.1186/s12875-022-01780-1 |
| _version_ | 1811281154467168256 |
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| author | Siona Decke Karina Hamacher Martin Lang Otto Laub Lars Schwettmann Ralf Strobl Eva Grill |
| author_facet | Siona Decke Karina Hamacher Martin Lang Otto Laub Lars Schwettmann Ralf Strobl Eva Grill |
| author_sort | Siona Decke |
| collection | DOAJ |
| description | Abstract Background In Germany, 19.1% of boys and 14.5% of girls are affected by mental health problems (MHP). Paediatricians are usually the first in line to be contacted but they often do not feel adequately trained to diagnose and treat MHP in primary care. A major statutory health insurance fund introduced a health coaching (HC) programme to strengthen primary care consultation for MHP. The HC includes a training concept for paediatricians, standardised guidelines for actions and additional payments. The aim of this study was to investigate the potential effects of the HC programme on the change of MHP in children and adolescents. Methods A prospective cohort study was conducted in Bavaria, Germany, in 2018 and 2019. Data were collected at 2 points 1 year apart using an online questionnaire. Parents of patients with developmental disorder of speech and language, head/abdominal pain, conduct disorder or non-organic enuresis were approached by their health insurance. Families treated according to the HC programme form the intervention group while all others serve as controls. MHP was assessed using the Strengths and Difficulties Questionnaire (SDQ) as a child self-assessment (SDQ-S)/or external assessment by parents (SDQ-P). Determinants of SDQ total score were analysed using linear mixed effects models. Results Cross-sectional (n = 1090) and longitudinal analyses (n = 599) were performed. At baseline, a total of 23.5% had an SDQ total score “at risk” (SDQ-S > 15/SDQ-P > 13). There were no significant differences between intervention and controls. After full adjustment for all potential confounders, higher SDQ scores indicating more problems were significantly associated with male sex (2.000, p < 0.001) whereas a high parental education level was significantly associated with decreased SDQ scores (-2.127, p =0.034). There was a significant improvement in the control group over time (-0.814, p = 0.001) while the SDQ scores in the intervention group remained stable (-0.012, p = 0.020). Conclusion This evaluation of the HC programme could not prove a clinically relevant intervention’s effect on the MHP developmental course. Nevertheless, (HC) paediatricians have crucial potential to improve the care of MHP patients. Targeting families with less access to support measures might help reduce the burden of MHP and be a step towards continuous improvement of care. |
| first_indexed | 2024-04-13T01:27:28Z |
| format | Article |
| id | doaj.art-4ce7dec88493409881b9dd0d6f35264f |
| institution | Directory Open Access Journal |
| issn | 2731-4553 |
| language | English |
| last_indexed | 2024-04-13T01:27:28Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj.art-4ce7dec88493409881b9dd0d6f35264f2022-12-22T03:08:35ZengBMCBMC Primary Care2731-45532022-08-0123111310.1186/s12875-022-01780-1Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort studySiona Decke0Karina Hamacher1Martin Lang2Otto Laub3Lars Schwettmann4Ralf Strobl5Eva Grill6Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU MunichBKK Vertragsarbeitsgemeinschaft BayernBerufsverband der Kinder- und Jugendärzte (BVKJ) e.V.PaedNetz Bayern e.V.Institute of Health Economics and Health Care Management (IGM), Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH)Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU MunichInstitute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU MunichAbstract Background In Germany, 19.1% of boys and 14.5% of girls are affected by mental health problems (MHP). Paediatricians are usually the first in line to be contacted but they often do not feel adequately trained to diagnose and treat MHP in primary care. A major statutory health insurance fund introduced a health coaching (HC) programme to strengthen primary care consultation for MHP. The HC includes a training concept for paediatricians, standardised guidelines for actions and additional payments. The aim of this study was to investigate the potential effects of the HC programme on the change of MHP in children and adolescents. Methods A prospective cohort study was conducted in Bavaria, Germany, in 2018 and 2019. Data were collected at 2 points 1 year apart using an online questionnaire. Parents of patients with developmental disorder of speech and language, head/abdominal pain, conduct disorder or non-organic enuresis were approached by their health insurance. Families treated according to the HC programme form the intervention group while all others serve as controls. MHP was assessed using the Strengths and Difficulties Questionnaire (SDQ) as a child self-assessment (SDQ-S)/or external assessment by parents (SDQ-P). Determinants of SDQ total score were analysed using linear mixed effects models. Results Cross-sectional (n = 1090) and longitudinal analyses (n = 599) were performed. At baseline, a total of 23.5% had an SDQ total score “at risk” (SDQ-S > 15/SDQ-P > 13). There were no significant differences between intervention and controls. After full adjustment for all potential confounders, higher SDQ scores indicating more problems were significantly associated with male sex (2.000, p < 0.001) whereas a high parental education level was significantly associated with decreased SDQ scores (-2.127, p =0.034). There was a significant improvement in the control group over time (-0.814, p = 0.001) while the SDQ scores in the intervention group remained stable (-0.012, p = 0.020). Conclusion This evaluation of the HC programme could not prove a clinically relevant intervention’s effect on the MHP developmental course. Nevertheless, (HC) paediatricians have crucial potential to improve the care of MHP patients. Targeting families with less access to support measures might help reduce the burden of MHP and be a step towards continuous improvement of care.https://doi.org/10.1186/s12875-022-01780-1Mental Health ProblemsChildren and AdolescentsPaediatricianHealth Coaching ProgrammeCohort Study |
| spellingShingle | Siona Decke Karina Hamacher Martin Lang Otto Laub Lars Schwettmann Ralf Strobl Eva Grill Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study BMC Primary Care Mental Health Problems Children and Adolescents Paediatrician Health Coaching Programme Cohort Study |
| title | Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study |
| title_full | Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study |
| title_fullStr | Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study |
| title_full_unstemmed | Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study |
| title_short | Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study |
| title_sort | longitudinal changes of mental health problems in children and adolescents treated in a primary care based health coaching programme results of the prima quo cohort study |
| topic | Mental Health Problems Children and Adolescents Paediatrician Health Coaching Programme Cohort Study |
| url | https://doi.org/10.1186/s12875-022-01780-1 |
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