JoAnna K Leyenaar, Cori M Green, Adam Turner, Laurel K Leslie
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引用次数: 0
Abstract
Objective: This study describes general and subspecialty pediatricians' experience of moral distress in providing care to children with mental health conditions, variation in moral distress across subspecialties, and associations between perceived care quality, practice characteristics, and moral distress.
Methods: This study analyzed survey data collected during 2022 American Board of Pediatrics Maintenance of Certification enrollment. Questions included perceived frequency with which high quality care was provided to children with mental health conditions (with suboptimal care quality defined as the lowest 2 response options on a 5-point Likert scale) and 4 potential sources of moral distress; high moral distress was defined as a top quartile composite score. Multivariable logistic regression was used to estimate associations between perceived suboptimal care quality, practice characteristics, and high moral distress.
Results: 5363 eligible pediatricians (55.2%) participated in the survey, including 3254 (60.7%) general pediatricians and 2109 (39.3%) subspecialists. Overall, 1147 (22.7%) reported perceived suboptimal care quality. Composite moral distress scores were highest for emergency medicine (n=106, 45.9% in highest quartile), child abuse (n=9, 39.1% in highest quartile), and hospital medicine physicians (n=109,32.5% in highest quartile). In regression analysis, high moral distress was associated with perceived suboptimal care quality, female gender, subspecialty, rurality, public insurance in practice, and academic appointment.
Conclusions: Approximately one-in-five pediatricians perceived suboptimal care quality for children with mental health conditions; this was associated with greater moral distress and several practice characteristics. Improving mental healthcare access, resources, and pediatricians' capacities to provide high quality care may benefit clinicians as well as children.
期刊介绍：
Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.
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